Entrapment of the Limb of an Endovascular Graft: A Peril of Saccular Aneurysms

Endoluminal repair of an infrarenal saccular aortic aneurysm was undertaken with a modular endovascular stent graft in a 74-year-old man. After deployment of the main body and right iliac limb of the graft, an attempt was made to gain guide wire access to the open short left limb of the graft for placement of the left iliac prosthesis. Attempts to gain access to the left limb graft from the left femoral artery area were unsuccessful. Since we were unable to pass the wire into the iliac system or snare it from below, can nulation from the left brachial artery was attempted. This resulted in the guide wire coiling up within the aneurysm. Eventual conversion to an open procedure confirmed that the short open left limb of the modular graft had deployed such that the opening was completely impacted against the inferior wall of the saccular aneurysm, preventing successful passage of a guide wire. The distance from the aortic neck to the base of the aneurysm is generally not considered an important parameter whe...