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Upside down use of Gore Excluder or Cook Zenith Legs

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Endovascular aneurysm repair is becoming increasingly popular. This technical note describes the usefulness of the upside-down technique of Gore Excluder or Cook Zenith legs.


Four patients with iliac or abdominal aortic aneurysms were treated. Three patients with isolated iliac artery aneurysms and one patient with an abdominal aortic aneurysm, in which the neck diameters were unfit for commercially available stent-grafts, were treated using an Excluder or a Zenith leg in an upside-down technique.


The aneurysms were completely excluded and no endoleak occurred. There were no serious adverse events.


The upside-down technique using an Excluder leg or a Zenith leg is both feasible and effective.

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Conflict of interest

Takatoshi Higashigawa, Noriyuki Kato, Takashi Hashimoto, Mikito Inouchi, Shuji Chino, Naoki Yamamoto, Uhito Yuasa, Toshiya Tokui, Yoshihiro Noda, Kensuke Oue, and Manabu Okabe have no conflict of interest.

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Correspondence to Takatoshi Higashigawa.

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Higashigawa, T., Kato, N., Hashimoto, T. et al. Upside down use of Gore Excluder or Cook Zenith Legs. Cardiovasc Intervent Radiol 37, 1068–1072 (2014). https://doi.org/10.1007/s00270-013-0802-0

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  • Upside-down technique
  • Endovascular aneurysm repair
  • Zenith
  • Excluder