Symptomatic Ipsilateral Limb Twisting Due to Extensive Rotational Re-orientation of the C3 Excluder

INTRODUCTION: Since the introduction of the Gore C3 device, which allows level re-positioning and contralateral gate cannulation, there have been very few reported complications due to excessive readjustment attempts. A case is reported of ipsilateral limb twisting and severe stenosis caused by extensive rotational re-orientation of the C3 system during a challenging intra-operative gate catheterisation. REPORT: Endovascular aortic aneurysm repair (EVAR) was performed for an infrarenal abdominal aortic aneurysm. Owing to difficulties encountered during contralateral gate cannulation using a Gore C3 device, the device was re-constrained and rotated clockwise several times, which induced twisting and severe symptomatic stenosis of the ipsilateral limb. The stenosed ipsilateral limb was successfully dilated with a bare stent two days after EVAR. DISCUSSION: Ipsilateral limb twisting due to extensive rotational re-orientation of the Gore C3 Excluder may occur during challenging intra-operative gate catheterisation. Thus, in cases that require extensive rotational re-orientation of the C3 system, it is advisable to carefully inspect for ipsilateral limb twisting during surgery.