Endovascular maneuvers for contralateral stent graft limb misplacement in endovascular aortic repair

Catheter Cardiovasc Interv. 2023 Dec;102(7):1271-1274. doi: 10.1002/ccd.30840. Epub 2023 Sep 11.

Abstract

Cannulation and placement of the contralateral stent graft limb during endovascular aortic repair (EVAR) procedure are crucial steps as mispositioning may lead to conversion to open aortic repair. Endovascular bail-out strategies for stent graft relocation in EVAR are underreported though detailed knowledge may facilitate application and prevent conversion. We present three endovascular bail-out strategies for repositioning of a mispositioned contralateral stent graft limb. (1) Retraction of the mispositioned component with an inflated reliant balloon and placement of an interposition stent graft after successful cannulation; (2) Push-maneuver of the mispositioned stent graft into the infrarenal aortic aneurysm with an inflated reliant balloon supported by a large lumen introducer sheath and (3) Parallel placement of a second contralateral stent graft limb displacing the mispositioned one against the atrial wall in cases with adequate vessel diameter. Prevention of stent graft mispositioning by applying recognized tests to ensure correct placement are essential, following the slogan: check twice, deploy once.

Keywords: EVAR; aortic aneurysm; cannulation; maldeployment; stent graft; strategy.

Publication types

  • Case Reports

MeSH terms

  • Aortic Aneurysm, Abdominal* / diagnostic imaging
  • Aortic Aneurysm, Abdominal* / surgery
  • Blood Vessel Prosthesis
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Blood Vessel Prosthesis Implantation* / methods
  • Endovascular Aneurysm Repair
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / methods
  • Humans
  • Stents
  • Treatment Outcome