A Method for Adjusting a Malpositioned Bifurcated Aortic Endograft

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Abstract
Purpose: To report the successful application of a method to adjust a malpositioned bifurcated stent-graft after endovascular aortic aneurysm repair. Method and Results: A 62-year-old male patient underwent endovascular repair of a 5.1-cm abdominal aortic aneurysm (AAA) with a Vanguard bifurcated stent-graft. After complete deployment of the stent-graft, the intraoperative completion angiogram disclosed unexpected occlusion of the left renal artery. Intra-aortic adjustment of the bifurcated graft was possible with a crossover guidewire, which was pulled caudally. The method worked perfectly to restore blood flow to the left renal artery. The patient is well 16 months postoperatively without any evidence of endoleak or graft migration; the left renal artery remains open. Conclusions: A technique is demonstrated for intra-aortic repositioning of a bifurcated stent-graft to correct insufficient deployment. If required, this technique should be attempted before conversion to an open procedure.