Capture and repositioning of third-generation migrated abdominal endovascular graft by bilateral femoral wire externalization and pulling by "horse-riding" technique followed by balloon EVG stabilization

Endovascular aneurysm repair is becoming the treatment of choice for elderly patients bearing abdominal aortic aneurysms with particular anatomical characteristics. Endovascular grafts are usually oversized to achieve sealing and minimize graft migration, the likelihood of which is also reduced by fixation hooks and barbs in the newer generation grafts. Yet, upward migration of the prosthesis, potentially compromising flow to renal and splanchnic vessels, may still occur acutely and requires timely management. We describe a patient with abdominal aortic aneurysm in whom proximal migration of an endovascular graft occurred, leading to renal and mesenteric artery obstruction, which was successfully managed by means of capturing and repositioning the device with a "horse-riding" technique followed by balloon stabilization of the graft to reduce the risk of re-dislodgment during controlateral leg insertion.