Malpositioned or dislocated aortic endoprostheses: Repositioning using percutaneous pull-down maneuvers

Purpose: To present the capabilities and potential complications of 2 percu taneous techniques for repositioning malpositioned or dislodged aortic endo grafts. Methods: Seven male patients (median age 67.9 years, range 59 to 78) requir ed correction of misplaced or dislocated endografts in the thoracic (n = 1) or infrarenal abdominal aorta (n = 6). In 1 patient, an infrarenal bifurca ted stent-graft was mistakenly deployed across a renal artery; repositionin g was accomplished by tugging caudally on a guidewire placed across the end ograft bifurcation and exteriorized from both femoral arteries. An inflated balloon catheter was used to reposition 3 dislocated aortic devices (1 tho racic, 2 infrarenal) and 3 iliac graft limbs that had disconnected from the main graft body 6 to 12 months after implantation. Results: Repositioning maneuvers were successful in all cases, with the dev ices being moved from 5 to 27 mm (median 7.8 mm). There were no procedure-r elated complications. Conclusions: Nonsurgical repositioning of misplaced aortic prostheses is te chnically feasible in individual cases. The risk associated with the proced ure, however, cannot yet be evaluated.