An elderly man was found to have a large infrarenal aortic aneursym. He was treated and an endograft was placed. Annual CT scans were performed, and for five years the device maintained its position and exclusion of the aneursym. The CT scan at year six noted that the device had collapsed into the aneursym sac, and the aneursym was again pressurized.

Further examination of the CT scan revealed that with collapse of the device, there was a large amount of metal just above the aortic bifurcation that might hinder any endovascular attempt at repair. As such, a plan was made to treat him in an hybrid Artis zeego^® room. The advanced imaging would allow more options endovascularly, as well as allow conversion to an open repair, if necessary.

Access to the arterial system was obtained from both femoral arteries. A syngo DynaCT was obtained which clarified the position and structural position of the old stent (Fig.1). A 3D angio was also performed which shows the position of the migrated device, and the endoleak (Fig. 2). 

Another endograft system, with suprarenal fixation was advanced from the right and positioned then deployed in position. The contralateral gate to this device was obstructed by the prior device's stent structure which had created a mass of wire at the aortic bifurcation (Fig. 3). 

Ultimately, a large balloon was used to deform the old stent, and then appropriate access to the new stent from the left was performed. The new stent system was completed and completion studies show an excellent result with exclusion of the aortic aneursym. A syngo DynaCT shows the relationship of the two devices, as well as the integrity of the repair, with no evidence of an endoleak (Fig. 4).

The patient is now six months post procedure and follow up CT scans show the new device in appropriate position and the aneursym excluded. He is doing well.