# Leg occlusion of the Ovation Alto stent graft main body caused by twisting of the stent graft: A case report

## TL;DR

A rare case of stent graft limb occlusion due to twisting during abdominal aortic aneurysm repair is reported.

## Contribution

This case report highlights a previously unreported complication of the Ovation Alto stent graft caused by device twisting.

## Key findings

- Twisting of the stent graft's main body led to polymer underfilling and limb occlusion.
- Rotation of the Ovation Alto stent graft should be avoided to prevent such complications.

## Abstract

The Ovation Alto stent graft is a unique endovascular abdominal aortic aneurysm repair device. A low-viscosity, radiopaque liquid polymer fills the rings located within the legs of the device. We reported a rare case of a patient diagnosed with an abdominal aortic aneurysm who was surgically treated using endovascular abdominal aortic aneurysm repair with an Ovation Alto stent graft. Polymer underfilling due to contralateral leg twisting of the stent graft’s main body resulted in limb occlusion. We highlighted the importance of avoiding the rotation of the Ovation Alto stent graft, thus preventing the potential twisting of this device within the sheath after the insertion of the stent graft’s main body.