Combined Surgical and Endovascular Removal of Thrombus Entirely Occluding a Bifurcated Aortic Stent-Graft

Abstract

Purpose:

To explore a method combining interventional, endovascular, and conventional surgical techniques for treating a completely occluded bifurcated stent-graft after endovascular aortic aneurysm repair.

Methods and Results:

A 60-year-old patient underwent endovascular repair of an abdominal aortic aneurysm (AAA) with a Talent bifurcated stent-graft. Five months later, after chronic thrombotic occlusion of the right iliac limb, he presented with acute occlusion of the entire stent-graft. Local intra-arterial infiltration thrombolysis successfully reconstituted flow through the main aortic segment and left iliac limb. With a combination of conventional surgical and intraoperative endovascular procedures, thrombectomy and recanalization of the right iliac limb was completed by stenting a severe stenosis of the proximal iliac limb.

Conclusions:

A combination of techniques may be essential for successful management of thrombotic complications after endovascular AAA repair.

Keywords

abdominal aortic aneurysm endovascular repair stent-graft occlusion endograft thrombolysis thrombectomy

Get full access to this article

View all access options for this article.

References

Blum

Voshage

Lammer

. Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms. N Engl J Med 1997; 336: 13–20.

Mialhe

Amicabile

Becquemin

. Endovascular treatment of infrarenal abdominal aortic aneurysms by the Stentor system: Preliminary results of 79 cases. J Vasc Surg 1997; 26: 199–209.

White

May

. Three-year experience with the White-Yu Endovascular-GAD Graft for transluminal repair of aortic and iliac aneurysms. J Endovasc Surg 1997; 4: 124–136.

Stelter

Umscheid

Ziegler

. Three-year experience with modular stent-graft devices for endovascular AAA treatment. J Endovasc Surg 1997; 4: 362–369.

White

May

. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms: Classification, incidence, diagnosis, and management. J Endovasc Surg 1997; 4: 152–168.

Parodi

Barone

Piraino

. Endovascular treatment of abdominal aortic aneurysms: Lessons learned. J Endovasc Surg 1997; 4: 102–110.

Chuter

TAM

Risberg

Hopkinson

. Clinical experience with a bifurcated endovascular graft for abdominal aortic aneurysm repair. J Vasc Surg 1996; 24: 655–666.

Thompson

Smith

Naylor

. Ultrasound-based quantification of emboli during conventional and endovascular aneurysm repair. J Endovasc Surg 1997; 4: 33–38.

Sandison

AJP

Edmondson

Panayiotopoulos

. Fatal colonic ischaemia after stent graft for aortic aneurysm. Eur J Vasc Endovasc Surg 1997; 13: 219–220.

10.

Mitchell

Dake

MID

Semba

. Endovascular stent-graft repair of thoracic aortic aneurysms. J Thorac Cardiovasc Surg 1996; 111: 1054–1062.

11.

Rogalla

Werner-Rustner

Huitema

. Virtual endoscopy of the small bowel: Phantom study and preliminary clinical results. Eur Radiol 1998; 8: 563–567.

12.

Dorffner

Thurnher

Polterauer

. Treatment of abdominal aortic aneurysms with transfemoral placement of stent-grafts: Complications and secondary radiologic intervention. Radiology 1997; 204: 79–86.

13.

Marin

MIL

Veith

Cynamon

. Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions. Ann Surg 1995; 222: 449–465.

14.

Nasim

Thompson

Sayers

. Endovascular repair of abdominal aortic aneurysm: An initial experience. Br J Surg 1996; 83: 516–519.

15.

Amesur

Zajko

Makaroun

. Treatment of a failed bifurcated abdominal aortic stent-graft with thrombolysis and Wallstent placement. J Vasc Interv Radiol 1997; 8: 795–798.