A METHOD FOR ADJUSTING A MALPOSITIONED BIFURCATED AORTIC ENDOGRAFT

Purpose: To report the successful application of a method to adjust a malpositioned bifurcated stent-graft after endovascular aortic aneurys m repair. Method and Results: A 62-year-old male patient underwent end ovascular repair of a 5.1-cm abdominal aortic aneurysm(AAA) with a Van guard bifurcated stent-graft. After complete deployment of the stent-g raft, the intraoperative completion angiogram disclosed unexpected occ lusion of the left renal artery. Intra-aortic adjustment of the bifurc ated graft was possible with a crossover guidewire, which was pulled c audally. The method worked perfectly to restore blood flow to the left renal artery. The patient is well 16 months postoperatively without a ny evidence of endoleak or graft migration; the left renal artery rema ins open. Conclusions:A technique is demonstrated for intra-aortic rep ositioning of a bifurcated stent-graft to correct insufficient deploym ent. If required, this technique should be attempted before conversion to an open procedure.