Endovascular Bailout Using Covered‐Stent Fenestration After Misdeployment of a Balloon‐Expandable Covered Stent From the Common Iliac Artery Into the Internal Iliac Artery

ABSTRACT

Misdeployment of balloon‐expandable covered stents extending from the common iliac artery (CIA) to the internal iliac artery (IIA) is a rare but serious complication. Optimal bailout strategies remain limited. Herein, we report a case of endovascular bailout for inadvertent stent deployment from the CIA to the IIA. A 68‐year‐old man presented with severe claudication of both legs. The bilateral ankle‐brachial index was low, and computed tomography showed chronic total occlusion of the left CIA. During revascularization, a balloon‐expandable covered stent was inadvertently deployed from the CIA into the IIA. To salvage the external iliac artery (EIA), a modified‐tip 0.035‐inch guidewire was used to perforate the stent graft, creating a fenestration. A 0.014‐inch guidewire was advanced through the newly created opening, followed by deployment of a self‐expanding bare‐nitinol stent across the fenestration to reconstruct the EIA flow. The final angiography indicated successful revascularization without complications. Therefore, percutaneous fenestration of a balloon‐expandable covered stent is a potential therapeutic option for the treatment of aortoiliac lesions.