Looped Balloon-Expandable Covered Stents for Bailout Hemostasis of Iliac Artery Injury

BACKGROUND: Balloon-expandable covered stents (VIABAHN VBX) are commonly used for iatrogenic arterial injuries. However, the outcomes of their use in loop configurations remain unclear. CASE SUMMARY: A man in his 80s experienced severe iliac artery injury during endovascular repair of common and internal iliac artery aneurysms. Sequential implantation of 4 stent grafts in a loop configuration with balloon dilation achieved hemostasis. Rebleeding was successfully managed with implantation of an additional stent graft and balloon dilation. DISCUSSION: Although junctional rebleeding should be recognized as a potential complication of looped stent grafts, it can be successfully managed. The patient remained asymptomatic with a preserved ankle-brachial pressure index at the 3-year follow-up. TAKE-HOME MESSAGE: The loop configuration of balloon-expandable covered stents may provide an effective bailout strategy for severe arterial injuries.