Angled guidewire delivery of aortic endovascular prostheses for angulated landing zones.

We present a case of a 90-year-old male with suprarenal, infrarenal, and bilateral iliac aneurysms with significant interval enlargement treated with an endovascular graft. Due to severe infrarenal neck angulation, a type 1a endoleak was encountered, which was successfully treated with an aortic cuff. A novel technique of cuff deployment over an angled guidewire to accommodate the aortic angulation was used. This represents the first report in the literature of using this technique to deal with difficult, angulated landing zones.