Successful treatment of aortic endograft thrombosis with rheolytic thrombectomy.
OBJECTIVE
To report the benefits of rheolytic thrombectomy for treating aortic endograft thrombosis.


METHODS
Of 40 patients who received the Ancure bifurcated endograft to treat abdominal aortic aneurysm (AAA) during a 9-month period, 6 (15%) patients (6 men; mean age 62.6 years, range 53-77) developed thrombosis of the endograft at an average of 9 weeks (range 1-20 months). Five patients were taking aspirin, and 3 were on warfarin therapy for atrial fibrillation. Immediately after angiography, rheolytic thrombectomy was used to remove the thrombus, followed by adjunctive procedures to treat the underlying pathology.


RESULTS
Causes were kinking or extrinsic compression of the graft limb in 5 cases and thrombosis of the surgical closure site in a common femoral artery. Mechanical thrombectomy was successful in restoring circulation in all cases; thrombolysis was used in 1. All 6 patients had additional stents placed in the graft limbs, re-establishing patency. There was no mortality or recurrent thrombosis in a follow-up that has extended to 26 months, but 1 patient required additional stenting for subsequent focal kinking of a graft limb above the previously implanted stent.


CONCLUSIONS
Rheolytic thrombectomy can safely and effectively treat endograft thrombosis after endovascular AAA repair. Additional thrombolytic agents, angioplasty, and stenting may be needed to correct the underlying causes of the thrombosis. Prophylactic stenting of iliac limbs at the time of implantation in patients with complex anatomy may prevent thrombosis of unsupported bifurcated endografts.
Krajcer
Zvonimir
Z
Department of Cardiology, Texas Heart Institute, St Luke's Episcopal Hospital, Houston, Texas 77030, USA. ZvonkoMD@aol.com
Gilbert
Jerry H
JH
Dougherty
Kathy
K
Mortazavi
Ali
A
Strickman
Neil
N
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001012:Aorta, Abdominal / Q000473:pathology* / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D001775:Blood Circulation / Q000502:physiology; D001807:Blood Vessel Prosthesis; D002408:Catheters, Indwelling; D020878:Device Removal; D005263:Femoral Artery / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007083:Iliac Artery / Q000473:pathology / Q000601:surgery; D007383:Intermittent Claudication / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012086:Reoperation; D015607:Stents; D013781:Texas; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors