Stent–Graft Malposition Into a False Lumen Causing Occlusion Following Blunt External Iliac Artery Injury: Case Report of a Novel Technique of Endovascular Therapy for Recanalization

Introduction Blunt trauma to the external iliac artery (EIA) is rare but potentially fatal. Endovascular stent-graft placement is used to control hemorrhage and restore limb perfusion. However, the safety profile and potential complications associated with stent-graft treatment are not well documented. We report a case of EIA injury following blunt trauma complicated by stent-graft deployment into a false lumen, successfully managed with an endovascular rescue technique. Case Report An 88-year-old man sustained blunt pelvic trauma with active extravasation from the left EIA. Initially, a covered stent-graft was deployed, which inadvertently caused arterial occlusion due to placement within a false lumen. A rescue procedure was performed using an endovascular approach, where a guidewire was advanced through the perigraft space and snared to establish a pull-through technique. Over this, a second stent-graft was deployed within the perigraft space, restoring flow through the true lumen. Follow-up computed tomography images confirmed successful recanalization and persistent exclusion of the false lumen. Conclusion This case highlights the potential for stent-graft misplacement in EIA trauma and the importance of ensuring access to the true lumen. Accessing the perigraft space and placing an additional stent-graft represents a new therapeutic approach to achieve recanalization in similar complex vascular injuries.