When performing endovascular aortic repair (EVAR) procedures, clinicians sometimes encounter cases in which the indications for EVAR are beyond the instruction for use (IFU). In EVAR, proximal neck fixation is the most important factor. This report describes several techniques and tips for EVAR in cases presenting with a difficult short neck or angled neck, especially when using the Gore Excluder®. Endo-wedge techniques (EWT), including non-sheath-assisted EWT with sheath-assisted strategies, are presented. We describe the scrum technique, which is a special procedure that is only feasible when using the Gore Excluder®. In this technique, intentional wire bending around the proximal neck portion occurs by pushing from both sides of the guidewire. This technique is applicable in cases with a sharply angled neck. The scrum with EWT is a more precise strategy for cases with a short or angled neck. Other troublesome cases include limb occlusion caused by weak points in the Gore Excluder® body and legs. The very rare complication of stent-graft collapse is also reviewed.
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