Squat and Jump: A Rare Case of Stent-Graft Migration During Deployment

While treating vascular aneurysms with endovascular technique, short neck and severe bending of the artery are one of the biggest challenges, whether choosing coil embolization or stent-graft (SG) deployment. Here, we report a case with large aneurysm of the splenic artery, which had anomalistically arisen from the superior mesenteric artery and had very severe bending. Because the proximal neck was too short to exclude with SG only, we decided to treat with a combination of coil embolization and SG. At the time of deploying the VIABAHN (self-expandable SG) at the ostium of the splenic artery, the VIABAHN started to deform as the strings were pulled and finally jumped away from the start position. A second VIABAHN was deployed using the sheath-covering technique, which involved alternating short deployment of the VIABAHN with short pullback of the sheath. This report highlights the tricks and traps of deploying VIABAHN at the arteries with very severe bending.