title: Heparin-Induced Thrombocytopenia Associated with a Heparin-Bonded Stent Graft.
abstract: We describe a case of heparin-induced thrombocytopenia (HIT) in association with heparin-bonded stent grafts. A 61-year-old man with claudication secondary to a left superficial femoral artery (SFA) occlusion was treated with 2 heparin-bonded polytetrafluorethylene (hep-PTFE) grafts. Despite the use of antiplatelet medication, he presented with thrombosed hep-PTFE grafts 1 week after initial treatment. An additional hep-PTFE graft was placed at the SFA origin because of migration of the first graft. He was discharged on anticoagulation; however, he presented again 2 weeks later with recurrent SFA thrombosis and a platelet count of 60,000, raising suspicion for HIT. All exogenous forms of heparin were discontinued, and he was started on an alternative anticoagulant. The patient returned again 5 days after being discharged with recurrent symptoms of acute limb ischemia. He underwent a left femoropopliteal artery bypass with autogenous conduit and removal of the grafts. He has since had an uneventful recovery. We believe HIT should be considered as a potential cause of hep-PTFE graft thrombosis. Diagnosis and management of these patients is complex and may require explantation of the graft.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Greenville Health System, Greenville, SC. Electronic address: JBlas@ghs.org.
authors.forename: Joseph-Vincent V
authors.initials: JV
authors.lastname: Blas
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Greenville Health System, Greenville, SC.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Carsten
authors.affiliation: Division of Vascular Medicine, Department of Surgery, Greenville Health System, Greenville, SC.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Gray
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D020099:Coated Materials, Biocompatible / Q000009:adverse effects*; D020878:Device Removal; D057915:Drug Substitution; D005263:Femoral Artery / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011474:Prosthesis Design; D012008:Recurrence; D012086:Reoperation; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D013927:Thrombosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D020099:Coated Materials, Biocompatible; D006493:Heparin