title: How should we manage thrombosis of Viabahn stent-graft? A case report focused on catheter-directed thrombolysis.
abstract: OBJECTIVE
  To report a case of a thrombosed GORE® VIABAHN® endoprosthesis stent-graft in the femoral artery (SFA) and popliteal artery managed using the pulse-spray technique and complicated by compartment syndrome of the lower leg of the affected limb.
  
  
  METHODS
  A 61-year-old woman with three Viabahn stent grafts relining seven bare-metal stents in her right SFA and popliteal artery visited our hospital with complaint of recurrent lifestyle-limiting claudication of right leg. Angiography and intravascular ultrasound showed complete intra-stent obstruction by thrombus from the proximal right SFA to the proximal popliteal artery. Catheter-directed thrombolysis using pulse-spray technique followed by mechanical thrombectomy was performed. Despite successful recanalization, unfortunately, compartment syndrome developed on her right leg on the following day and fasciotomy was performed.
  
  
  CONCLUSIONS
  The larger thrombus burden in Viabahn stent-grafts and its unique physicochemical properties increases the risk for distal embolic complications and potential poor clinical outcomes.
authors.affiliation: Section Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Won Yu
authors.initials: WY
authors.lastname: Kang
authors.affiliation: Section Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Umberto
authors.initials: U
authors.lastname: Campia
authors.affiliation: Section Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Nelson Lim
authors.initials: NL
authors.lastname: Bernardo
authors.affiliation: Section Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Romain J
authors.initials: RJ
authors.lastname: Didier
authors.affiliation: Section Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Smita I
authors.initials: SI
authors.lastname: Negi
authors.affiliation: Section Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Sarkis
authors.initials: S
authors.lastname: Kiramijyan
authors.affiliation: Section Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Edward
authors.initials: E
authors.lastname: Koifman
authors.affiliation: Section Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Nevin C
authors.initials: NC
authors.lastname: Baker
authors.affiliation: Section Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: Section Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Ricardo O
authors.initials: RO
authors.lastname: Escarcega
authors.affiliation: Section Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Section Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D015901:Angiography, Digital Subtraction; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D003161:Compartment Syndromes / Q000209:etiology / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011150:Popliteal Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D015607:Stents; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D005343:Fibrinolytic Agents
keywords: Compartment syndrome; Thrombolysis; Thrombosis; Viabahn stent-graft