An EVAR as unique as your patients,
No two patients are alike – the ALTO® abdominal stent graft system
provides a custom seal and conforms to the needs of specialized anatomies.

Durability From All Angles

Across All Anatomies, Choose ALTO

Long-term data from independent, non-sponsored studies feature Adaptive Sealing Technology and show that ALTO delivers what others can only claim: independent, real-world proof that durable outcomes are possible, even in hostile necks.

10-Year Data*

Long-Term Outcome Results of the
Ovation Stent Graft 2

Debbaut et al., 2026 | JVS-Vascular Insights

92 patients | 71% hostile neck anatomy

95.9%

freedom from late Type
Ia endoleak at 10 years

Long-Term Outcomes of the Ovation Stent
Graft System: Single-Center Experience 3

Fino et al., 2025 | Journal of Clinical Medicine

99 patients | 45.5% hostile neck anatomy

100%

freedom from late Type
Ia endoleak at 10 years

0%

EVAR/AAA-related
mortality

* The 10-year clinical outcomes discussed reflect data from the ovation platform and Adaptive Sealing Technology (AST) experience. ALTO incorporates the same foundational AST but was introduced more recently and therefore does not have 10 years of device-specific follow-up. Long-term outcome data include patients treated with earlier-generation Ovation devices utilizing AST

5-Year Data

Polymer Ring Sealing Stents for Abdominal
Aortic Aneurysms With “Hostile Neck” Feature:
A Safe Alternative for Patients “Less Fit” for
Open Repair1

Elsayed et al., 2026 | Seminars in Vascular Surgery

63 patients | 100% hostile neck anatomy

93.7%

freedom from
reintervention at
5 years

100%

of patients considered
on-label ONLY for
Endologix Adaptive
Sealing Technology

ALTO featured in “The Role of Adaptive Sealing Technology in Clinical Practice” article.

Read It Now

50%

of AAA patients requiring treatment are not eligible for on-label+ EVAR4-8

+Due to specialized anatomies.

Off-label EVAR is mostly due to:

Short neck length

Small access vessel diameter

Excessive neck angulation

ALTO offers a personalized experience to

meet the individual needs of each patient’s anatomy.

ALTO’s exclusive technology is optimized for specialized anatomies, including tortuous iliacs
and short necks:
7mm neck indication
13F ID delivery system
Highly comformable limbs

You need an EVAR solution

as unique as they are

Featuring Adaptive Sealing Technology­­ –
only on the ALTO abdominal stent graft system.

ALTO's exclusive adaptive sealing technology

creates an effective seal around the vessel wall,

conforming to the patient’s anatomy. This technology eliminates chronic radial force in the seal zone** and results in stable neck diameters out to 5 years4,5
Adaptive with sealing ring conforming to irregular surface, creating a patient specific seal.
Separation of fixation and seal allows you to fixate in healthy tissue and seal closest to renals.
Treat infrarenal neck lengths as short as 7mm and ­<60° juxtarenal angulation without adjunctive devices.
ALTO’s integrated balloon enables time-saving interoperative deployment and optimizes the molding of the sealing ring.
Proprietary crossover lumen allows easy cannulation.
PTFE iliac limbs with helical nitinol architecture provide flexibility and minimal luminal encroachment.
97.2% Freedom from secondary intervention due to graft occlusion at 5 years.^
Made to Conform
Built to Perform

**Seal zone for the ALTO stent graft is defined as a location 7mm down for the lowest renal.
^The ENCORE analysis pools data on file from ENCORE Data File: April 12, 2018.

Where versatility and durability meet

The ENCORE*** analysis

a pooled, retrospective analysis of six trials demonstrated
favorable clinical outcomes over five years.

0 %

Freedom from AAA-related mortality

0 %

Freedom from
conversion

0 %

Freedom from
rupture

0 %

Freedom from
reintervention for type IA endoleak

0 %

Freedom from
device-related reintervention

***The Ovation platform product family includes a series of device iterations using adaptive neck sealing technology such as Ovation, Ovation Prime, Ovation iX, and ALTO. The devices included in the studies used in the ENCORE analysis all include adaptive sealing technology. ALTO was not included in the ENCORE data set. ENCORE includes results from real-world patient population. 3% of patients had neck characteristics beyond the FDA-approved anatomic IFU. Safety and effectiveness of Ovation and ALTO when used outside the IFU have not been established.
The ENCORE analysis pools data on file from March 20, 2019.

Click Image To Zoom-In

Anatomically adaptive, uniquely powerful

ALTO Testimonial Case Examples

highlight the clinical utility including patient demographics, pre-case planning, intra and post-op results.

Dr. Nicolas Mouawad from McLaren Health System

Short Aortic Neck Case

Dr. Luis Gomez from St. Joseph Regional Medical Center

Severe Infrarenal Neck Angulation Case

Dr. Venkatesh Ramaiah from HonorHealth Scottsdale Shea Medical Center

Severe Infrarenal Neck Angulation Case Review

Dr. Venkatesh Ramaiah from HonorHealth Scottsdale Shea Medical Center

Large AAA with Small Access Vessels Case Review

Dr. Venkatesh Ramaiah from HonorHealth Scottsdale Shea Medical Center

Short and Angulated Neck Case Review

Dr. Robert Beaulieu from the University of Michigan

Large Infra-renal Aortic Aneurysm Case Review

Dr. Luis Gomez ALTO Case Review

Experience ALTO today:
Sign up for VR training demo.

Learn More

Contact Us:

Contact Us

I want to explore further:

ALTO Downloads:
Product Brochure
Reference Guide
Find IFU
ENCORE Infographic
Evolving EVAR Infographic
The Role of Adaptive Sealing Technology
Physician AAA Coding Guide
Facility Coding & Reimbursement AAA
Clinical Update 2022
Clinical Update 2025
Other Links:
Related Studies
Videos
Webinars
News

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These are a portrayal of typical EVAR patients and not real patients.

REFERENCES
  1. Elsayed Y, Bakheet M, Ahmed N, et al. Polymer ring sealing stents for abdominal aortic aneurysms with “hostile neck” feature: a safe alternative for patients “less fit” for open repair. Annals of Vascular Surgery. 2026;129:437-442. doi:https://doi.org/10.1016/j.avsg.2026.03.039
  2. Debbaut T, Fourneau I, Maleux G, et al. Long-term outcome results of the Ovation stent graft. JVS-Vascular Insights. 2026;4:100439.doi:https://doi.org/10.1016/j.jvsvi.2026.100439
  3. Fino G, Isernia G, Parlani G, et al. Long-term outcomes of the ovation stent graft system: single-center experience. Journal of Clinical Medicine. 2025;14(12):4177. doi:https://doi.org/10.3390/jcm14124177
  4. Barleben A, et al. Long-term outcomes of the Ovation Stent Graft System investigational device exemption trial for endovascular abdominal aortic aneurysm repair.
    J Vasc Surg. 2020;72(5):1667-1673.
  5. Elkouri S, et al. Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts.
    Vasc Endovascular Surg. 2004;38:401-12.
  6. Arko FR, et al. How many patients with infrarenal aneurysms are candidates for endovascular repair? The Northern California experience. J Endovasc Ther. 2004;11:33-40.
  7. AbuRahma AF, et al. Aortic neck anatomic features and predictors of outcomes in endovascular repair of abdominal aortic aneurysms following vs not following
    instructions for use. J Am Coll Surg. 2016;222:579-89.
  8. Schanzer A, et al. Predictors of abdominal aortic aneurysm sac enlargement after endovascular repair. Circulation. 2011;123:2848-55.
Legal Information:

INDICATIONS FOR USE:
The ALTO® Abdominal Stent Graft System is indicated for treatment of patients with infrarenal abdominal aortic aneurysms having the vascular morphology suitable
for endovascular repair with the device, which includes the following:

  • Adequate iliac/femoral access compatible with vascular access techniques (femoral cutdown or percutaneous), devices, and/or accessories,
  • A proximal aortic landing zone for the sealing ring 7 mm below the inferior renal artery.
  • An aortic sealing zone comprised of healthy aorta defined as:
    • Lack of significant thrombus > 8 mm in thickness; at any point along the aortic circumference at the level of 7mm below the inferior renal artery,
    • Lack of significant calcification at the level of 7 mm below the inferior renal artery,
    • Conicity < 10% as measured from the inferior renal artery to the aorta 7 mm below the inferior renal artery,
    • An inner wall diameter of no less than 16 mm and no greater than 30 mm at 7 mm below the inferior renal artery, and
    • An aortic angle of ≤ 60 degrees
  • A distal iliac landing zone:
    • With a length of at least 10 mm, and
    • With an inner wall diameter of no less than 8 mm and no greater than 25 mm.

CONTRAINDICATIONS: The system is contraindicated for use in patients who have a condition that threatens to infect the graft and in patients with known sensitivities or allergies to the
device materials including polytetrafluoroethylene [PTFE], polyethylene glycol [PEG]-based polymers, contrast agents, fluorinated ethylene propylene [FEP], titanium, nickel, platinum, or iridium.

Refer to Instructions for Use for more information concerning Indications, Contraindications, Specific Anatomic Considerations, Warnings, Precautions, and Adverse Events.

CAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician.

NOTE: Not all product components are available in every country. Please consult with your Endologix representative to confirm product availability.

Endologix is a registered trademark of Endologix LLC in the United States, Europe and Japan and ALTO is a registered trademark of Endologix LLC and its subsidiaries. All other trademarks are the property of their respective owners.

©2026 Endologix LLC. All rights reserved. MM2631-All Rev 03