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

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.