This study demonstrates that ACD use in patients with peripheral artery disease can lead to serious adverse events resulting in increased morbidity. Therefore, the potential benefits of an ACD over MC should be carefully weighed.

Results: Our video shows the explantation of an aortic endograft and subsequent aneurysm repair with a bifurcated Hemashield Dacron graft with preservation of the endograft iliac limbs. A brief period of suprarenal clamping was required while the endograft was removed. A Dacron graft was then anastomosed to the infrarenal aorta using techniques that will be described to buttress the proximal aortic neck. A persistent type Ib endoleak was treated by wrapping the left common iliac artery (CIA) with a Dacron graft to seal the artery onto the iliac endograft as well as by placating the orifice of the CIA. The patient was discharged to rehabilitation on postoperative day 16 and continues to do well 2 months later.Conclusions: Removal of an endograft results in thinning of the aortic wall. To repair this aneurysm with an infrarenal graft, it is important to reinforce the aortic neck using techniques described in our video. As the number of EVAR patients, increases it is expected that this complication may be encountered more frequently.