Endovascular aneurysm repair (EVAR) has become an effective and reliable therapy. Although EVAR is less invasive than open surgery,
it possesses various disadvantages. Graft limb occlusion is an important complication of EVAR and the third most common reason for
readmission after EVAR. In this report, we present a late complication of EVAR due to graft migration resulting in severe stenosis of
the external iliac artery and recurrent distal arterial thrombosis. A 60-year-old male patient was admitted with acute-onset left leg pain.
His medical history revealed EVAR treatment two years previously. During the last two months, he developed symptoms of claudication.
Imaging studies revealed that the left superficial femoral artery was obstructed by thrombi, and the left leg of EVAR graft was positioned
close to the internal iliac artery causing severe ostial stenosis in the external iliac artery. Also, a Type Ib endoleak was detected. Due to
critical lower extremity ischemia, emergency embolectomy was performed. Three days later, a saphenous femorotibial bypass was performed
for claudication and the leg of the EVAR graft was extended simultaneously. In conclusion, EVAR has advantages over open repair.
Nevertheless, it is associated with a high rate of complications requiring reintervention. Therefore, open surgery should be the first choice
in challenging cases.
Key words: Endovascular procedure, limb salvage, saphenous vein, vascular grafting.
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