Tanenbaum Mira T, Klein Andrea E, Babb Jacqueline L, Baig Mirza S, Kirkwood Melissa L, Timaran Carlos H
Department of Surgery, George Washington University Hospital, Washington, DC.
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
J Vasc Surg Cases Innov Tech. 2025 Jun 9;11(5):101874. doi: 10.1016/j.jvscit.2025.101874. eCollection 2025 Oct.
Endovascular aortic aneurysm repair (EVAR) offers a minimally invasive treatment approach for abdominal aortic aneurysms (AAAs). Iliac limb misdeployment outside of the gate is a rare complication that traditionally requires open conversion. We describe two cases of limb misdeployment salvaged with laser fenestration (ISLF). An ISLF was created through the misplaced iliac limb into the aneurysm sac, allowing for subsequent gate cannulation. A new limb was then deployed from the gate through the fenestration into the iliac artery. These cases demonstrate that ISLF through a misdeployed EVAR limb is a novel bail-out endovascular technique that circumvents open surgery and restores the aortoiliac anatomic continuity of the repair.
血管内主动脉瘤修复术（EVAR）为腹主动脉瘤（AAA）提供了一种微创治疗方法。髂支在支架移植物开口外部署错误是一种罕见的并发症，传统上需要转为开放手术。我们描述了两例通过激光开窗术（ISLF）挽救髂支部署错误的病例。通过错位的髂支创建一个ISLF进入动脉瘤腔，以便随后进行支架移植物开口插管。然后通过开窗从支架移植物开口向髂动脉部署一个新的髂支。这些病例表明，通过错位的EVAR髂支进行ISLF是一种新型的血管内补救技术，可避免开放手术并恢复主动脉髂部修复的解剖连续性。
