The FDA approval of endovascular grafts for the treatment of @entity1028 has been associated with a dramatic increase in the use of these devices. Major referral centers are reporting the treatment of 75% to 80% of their @entity1 with @entity1028 with endovascular devices. The large quantity of endovascular devices being used has produced a growing number of management issues that are often not predictable during the preoperative assessment. These issues require complex intraoperative decision making and innovative techniques for their management as reflected by the subsequent case report. An 82-year-old @entity1 presented with a 7.8-cm @entity1028 . The @entity439 extended into the common iliac arteries bilaterally. The right common iliac artery was 6.5 cm and the left common iliac artery was 2.0 cm in maximal diameter. The preoperative work-up, including a computed tomography scan and arteriogram, suggested that he would be a potential candidate for endovascular repair. The plan was to extend the graft into the right external iliac artery after embolization of the right hypogastric artery and to seal the left limb in the ectatic left common iliac artery using an aortic extender cuff. During the endovascular repair of the @entity439 using the AneuRx bifurcated graft, the main device became dislodged from its infrarenal attachment site and migrated into the large right common @entity1029 with the iliac limb ending in the distal external iliac artery. A new bifurcated device was deployed from the left side to attempt an endovascular salvage of the difficult situation. The new graft was partially deployed down to the iliac limb. This allowed cannulation of the contralateral stump through the original endovascular graft that had migrated distally. The two grafts were connected with a long iliac limb. This allowed stabilization of the endovascular reconstruction by increasing its columnar strength. The deployment of the second bifurcated graft was completed and the central core with the runners removed safely without migration of the second bifurcated component. The reconstruction was completed with an aortic cuff in the left common iliac artery. The use of the aortic cuff was useful to preserve the left hypogastric artery. No intraoperative endoleak was noted. The @entity1 did well and was discharged the day following the procedure. The follow-up computed tomography scan shows the @entity1028 excluded by the endovascular graft with a defunctionalized portion of one bifurcated graft within the right common @entity1029 . There is no evidence of endoleak and the @entity1028 had decreased in size at 6 months. This case demonstrates one of the unique management problems that may arise during endovascular graft placement. Events that initially would suggest failure of the endoluminal treatment may be corrected using advanced endovascular techniques by an experienced surgeon. However, there will be times that the prudent decision will be conversion to open repair. Only good clinical judgement and adequate training will prevent catastrophic outcomes.

Migration of a bifurcated endovascular graft into an XXXX : endovascular salvage and future prevention--a case report.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity1029 :: ('MESH:D017543', 'Disease') :: ['iliac aneurysm', 'iliac artery aneurysm'] @entity439 :: ('MESH:D000783', 'Disease') :: ['aortoiliac aneurysms', 'aneurysm'] @entity1028 :: ('MESH:D017544', 'Disease') :: ['abdominal aortic aneurysms', 'infrarenal abdominal aortic aneurysms', 'abdominal aortic aneurysm']
@entity1029 :: (MESH:D017543,Disease) :: ['iliac aneurysm']
