title: Bifurcated aortoiliac endograft limb occlusion during deployment and its bailout conversion using the external iliac artery to internal iliac artery endograft technique.
abstract: Endovascular aneurysm repair has become the preferred method to treat abdominal aortic aneurysms (AAAs). The Ovation TriVascular Stent-Graft system introduces a unique concept of separation of the metal (stent) and fabric (graft) portion of the endograft's main body to facilitate delivery through ultra-low profile 14F devices. In the setting of a narrow distal aneurysmal lumen, usually due to the presence of thrombus, deployment of this endograft may be complicated by folding and collapse of the (unsupported by a stent) aortic body or limbs, making catheterization and ballooning impossible. We present a case of Ovation endograft contralateral limb collapse in a tight AAA lumen due to thrombus deposition, which led to folding and total occlusion of the limb and made limb catheterization impossible. This is a real-life example of how the external iliac artery to internal iliac artery endograft technique may be used as a bailout procedure, converting the procedure into an aortouni-iliac graft. To our knowledge, this is the first reported bailout use of this technique in English literature which may be used in selected cases.
authors.affiliation: Interventional Radiology Unit, University of Crete Medical School, Heraklion, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Kehagias
authors.affiliation: Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kontopodis
authors.affiliation: Interventional Radiology Unit, University of Crete Medical School, Heraklion, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsetis
authors.affiliation: Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece. Electronic address: ioannou@med.uoc.gr.
authors.forename: Christos V
authors.initials: CV
authors.lastname: Ioannou
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome