Heparin-induced thrombocytopenia and graft thrombosis following endovascular aneurysm repair.
OBJECTIVE
To report a case of heparin-induced thrombocytopenia (HIT) complicated by stent-graft thrombosis.


METHODS
An 82-year-old woman underwent endovascular aortic aneurysm repair using a Zenith stent-graft. She returned 2 weeks later with an occluded graft limb, large quantities of thrombus lining the remainder of the stent-graft, thrombocytopenia, and antiplatelet antibodies. There were no signs of kinking or compression of the graft, nor was there any thrombosis of the native arteries downstream from the occluded graft limb. Thrombolysis restored graft patency. Anticoagulation was induced using hirudin and warfarin. The graft remains patent at 6-month follow-up.


CONCLUSIONS
HIT is a rare cause of postoperative endograft thrombosis. In this case, the presumed source of the inciting heparin dosage was the stent-graft itself, which had been soaked in a concentrated heparin solution prior to insertion.
Chuter
Timothy A M
TA
Division of Vascular Surgery, University of California, San Francisco, California 94143, USA. chutert@surgery.ucsf.edu
Pak
Laura K
LK
Gordon
Roy L
RL
Reilly
Linda M
LM
Messina
Louis M
LM
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000628:therapy*; D001027:Aortography; D021721:Balloon Occlusion / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000379:methods; D014654:Vascular Patency
D006493:Heparin