Avulsion of the Distal Sealing Stent of a Zenith Aortouni-iliac Stent-Graft.

PURPOSE: To describe a life-threatening complication during endovascular aneurysm repair that was caused by a series of errors.

CASE REPORT: A 64-year-old man received a Zenith aortouni-iliac stent-graft for a 61-mm saccular aortic aneurysm. During retrieval of the delivery system, the sheath became dislodged from the common femoral artery. Reintroduction caused the top cap to disengage from the pusher rod because the pin vice had not been tightened as per the instructions for use. Subsequent traction was applied but the delivery system could not be withdrawn from the sheath, thus it was decided to remove the delivery system and sheath en masse. On removal, the distal sealing stent was found deformed and wedged between the top cap and the sheath. Perforation of the common iliac artery by the avulsed stent was treated with iliac limb extension before contralateral iliac plug and femorofemoral bypass graft were performed as planned. The patient made an uneventful recovery.

CONCLUSION: Trapping of the distal sealing stent between the top cap and the pusher rod of the Zenith graft is possible and can be prevented by securing the pin vice prior to retrieval. Description of this complication may prevent similar occurrences in future.