Endovascular aortic retrieval of migrated iliac stent

Stent maldeployment or migration during endovascular intervention is an uncommon but potentially catastrophic complication, with limited guidance on optimal management strategies. A 43-year-old woman with lifestyle-limiting left lower extremity claudication presented for a second opinion 12 weeks after left common iliac artery stenting at an outside institution. Computed tomography angiography demonstrated migration of a self-expanding iliac stent into the infrarenal abdominal aorta. The patient was asymptomatic from the migration but remained symptomatic from the underlying iliac disease. Endovascular retrieval was pursued using bilateral femoral access. A 10-mm balloon was inflated within the stent for stabilization, followed by capture with a snare and extraction through a 14F sheath. Completion angiography revealed a retained stent fragment near the left common iliac artery origin, which was successfully retrieved using endovascular forceps. Intravascular ultrasound confirmed complete removal and guided definitive treatment with placement of a 7-mm balloon-expandable covered stent in the left common iliac artery. The procedure was completed without vascular injury, and the patient was discharged the same day. At 1-month follow-up, claudication had fully resolved, duplex ultrasound demonstrated stent patency, and ankle-brachial indices were normal bilaterally. This case highlights that delayed endovascular retrieval of a migrated iliac stent is feasible and safe, and emphasizes the importance of a flexible endovascular toolkit and meticulous imaging to achieve complete foreign body removal and durable revascularization.