The proximal graft and the distal graft separated creating a type 3 endoleak.Surgical intervention was required.The distal fenestrated component lost its overlap with the proximal fenestrated component.The distal component migrated down into the aneurysm at a difficult angle posteriorly.Also, the right and left iliac limbs lost seal within the common iliacs and migrated up into the aneurysm.The distal fenestrated graft and limbs folded in the aneurysm making reintervention difficult.Physician accessed the axillary artery and put a 8fr sheath down into the aorta.He stented the superior mesenteric artery with a gore 8x29 vbx and stented the left renal artery with a gore 6x29 vbx.He then drove a wire down into the proximal fenenstrated graft.He was able to snake the wire into the distal graft and through the left iliac limb.The physician accessed both femoral arteries and then from the left side snared the wire from above.Once he had wire access he exchanged it to a stiff wire which helped straighten out the folded graft.He then accessed the patients right femoral artery with a wire and was able to get access into the aorta from both sides.He decided to reline the graft with a gore excluder graft.After the relining the grafts with the gore endografts an angiogram confirmed that the aneurysm was now sealed with no endoleak.
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