Aneurysm sac re-expansion after thrombolysis.
OBJECTIVE
To present a case of delayed abdominal aortic aneurysm (AAA) re-expansion after thrombolysis for endograft limb occlusion.


METHODS
A 68-year-old man underwent AAA exclusion with an AneuRx stent-graft in 1999. Five years later, he developed right limb thrombosis of the endograft. He underwent right limb thrombolysis and AngioJet thrombectomy. The patient experienced abdominal and back pain during the procedure, and the aneurysm sac, which had remained reduced in size for several years, acutely re-expanded. The patient was managed conservatively. The fluid that accumulated in the sac was reabsorbed, and the AAA returned to its previous dimensions at 1-month follow-up.


CONCLUSIONS
Symptomatic re-expansion of the aneurysm sac after AngioJet rheolytic thrombectomy may occur when the graft is stripped of neointima by the "power-pulse" spray of lytic agent, allowing serum to seep into the sac. Based on this experience, we advise caution when delivering thrombolytics using the AngioJet "power-pulse" spray mode in patients with a thrombosed stent-graft.
Garibaldi
Abel A
AA
Department of Cardiovascular Surgery, Texas Heart Institute and St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Krajcer
Zvonimir
Z
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012008:Recurrence; D015607:Stents; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation; D013927:Thrombosis / Q000188:drug therapy* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator