title: Symptomatic Intragraft Thrombus following Endovascular Repair of Blunt Thoracic Aortic Injury.
abstract: Thoracic endovascular aortic repair (TEVAR) can be complicated by graft collapse, endoleaks, and stent migration. The incidence of these complications and other outcomes is poorly understood in young trauma victims who receive endovascular aortic repair of blunt thoracic aortic injury (BTAI). A 29-year-old pedestrian was struck by a vehicle resulting in polytrauma including BTAI with transection distal to the left subclavian artery origin. The patient underwent successful TEVAR. Nine months later, the patient developed transient paresthesia below the waist that progressed to bilateral lower extremity paralysis and malperfusion syndrome below the diaphragm including nonpalpable pulses in the lower extremities, acute renal failure, and ischemic colitis. Imaging demonstrated near occlusive thrombosis of the distal end of the thoracic endograft. An emergent axillobifemoral bypass resolved the organ malperfusion and acute limb ischemia. Patients who have undergone TEVAR for BTAI may develop asymptomatic or symptomatic intragraft thrombosis. In patients presenting with malperfusion syndrome below the diaphragm, extra-anatomic bypass can expeditiously resolve symptoms until definitive treatment can be performed. Oversizing of thoracic stents in trauma patient may lead to intragraft thrombosis.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Sherwin
authors.initials: S
authors.lastname: Abdoli
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Sung Wan
authors.initials: SW
authors.lastname: Ham
authors.affiliation: Department of Radiology, University of Southern California, Los Angeles, CA.
authors.forename: Alison G
authors.initials: AG
authors.lastname: Wilcox
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Fleischman
authors.affiliation: Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA. Electronic address: Lydia.Lam@med.usc.edu.
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D000072226:Computed Tomography Angiography; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008297:Male; D000069636:Pedestrians; D011474:Prosthesis Design; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*