title: Successful treatment of aortic endograft thrombosis with rheolytic thrombectomy.
abstract: 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.
authors.affiliation: Department of Cardiology, Texas Heart Institute, St Luke's Episcopal Hospital, Houston, Texas 77030, USA. ZvonkoMD@aol.com
authors.forename: Zvonimir
authors.initials: Z
authors.lastname: Krajcer
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gilbert
authors.forename: Kathy
authors.initials: K
authors.lastname: Dougherty
authors.forename: Ali
authors.initials: A
authors.lastname: Mortazavi
authors.forename: Neil
authors.initials: N
authors.lastname: Strickman
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors