Collapsed bifurcated modular infrarenal endograft

Bilateral acute limb ischemia after endovascular aneurysm repair is extremely rare. We present the case of a 70-year-old man treated by endovascular aneurysm repair for a 7.9-cm asymptomatic infrarenal abdominal aortic aneurysm using a bifurcated modular GORE EXCLUDER endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz). The initial recovery was uneventful, but 14 days later, the patient presented with bilateral acute limb ischemia caused by collapse and thrombosis of the endograft, requiring emergency axillobifemoral bypass, fasciotomies, and subsequent endograft removal with open aneurysm repair. The patient had no other complications at 7 months of follow-up. Oversizing of a GORE EXCLUDER graft because of a conical neck, a small bird-beak configuration, and a long angulated neck with aortoiliac tortuosity were potential contributing factors to endograft infolding and collapse.