Endovascular aortic repair endograft limb misdeployment salvaged with laser fenestration

Endovascular aortic aneurysm repair (EVAR) offers a minimally invasive treatment approach for abdominal aortic aneurysms (AAAs). Iliac limb misdeployment outside of the gate is a rare complication that traditionally requires open conversion. We describe two cases of limb misdeployment salvaged with <i>in situ</i> laser fenestration (ISLF). An ISLF was created through the misplaced iliac limb into the aneurysm sac, allowing for subsequent gate cannulation. A new limb was then deployed from the gate through the fenestration into the iliac artery. These cases demonstrate that ISLF through a misdeployed EVAR limb is a novel bail-out endovascular technique that circumvents open surgery and restores the aortoiliac anatomic continuity of the repair.