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Symptomatic Intragraft Thrombus following Endovascular Repair of Blunt Thoracic Aortic Injury.

Abstract：

:Thoracic endovascular aortic repair (TEVAR) can be complicated by graft collapse, endoleaks, and stent migration. The incidence of these complications and other outcomes is poorly understood in young trauma victims who receive endovascular aortic repair of blunt thoracic aortic injury (BTAI). A 29-year-old pedestrian was struck by a vehicle resulting in polytrauma including BTAI with transection distal to the left subclavian artery origin. The patient underwent successful TEVAR. Nine months later, the patient developed transient paresthesia below the waist that progressed to bilateral lower extremity paralysis and malperfusion syndrome below the diaphragm including nonpalpable pulses in the lower extremities, acute renal failure, and ischemic colitis. Imaging demonstrated near occlusive thrombosis of the distal end of the thoracic endograft. An emergent axillobifemoral bypass resolved the organ malperfusion and acute limb ischemia. Patients who have undergone TEVAR for BTAI may develop asymptomatic or symptomatic intragraft thrombosis. In patients presenting with malperfusion syndrome below the diaphragm, extra-anatomic bypass can expeditiously resolve symptoms until definitive treatment can be performed. Oversizing of thoracic stents in trauma patient may lead to intragraft thrombosis.

journal_name

Ann Vasc Surg

journal_title

Annals of vascular surgery

authors

Abdoli S,Ham SW,Wilcox AG,Fleischman F,Lam L

doi

10.1016/j.avsg.2016.12.007

subject

Has Abstract

pub_date

2017-07-01 00:00:00

pages

305.e7-305.e12

eissn

0890-5096

issn

1615-5947

pii

S0890-5096(16)30966-9

journal_volume

42

pub_type

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