Intima Migration from the Iliac Artery to a Debranched Graft after Thoracic Endovascular Aortic Repair

An 84-year-old woman underwent single-debranched thoracic endovascular aortic repair for aortic aneurysm. A few hours later, malperfusion of the left upper extremity occurred. Surgical exploration revealed a tubular-shaped intima packed in the debranched graft. As computed tomography showed localized dissection in the right external iliac artery probably due to access route injury, the intima roll was thought to have migrated from the iliac artery. This extremely rare case is described in detail with a discussion of the potential mechanism.