Late Stent Thrombosis in a Patient with Endovascular Aortic Repair for Blunt Thoracic Aortic Injury

Table 1

Case reports of thoracic endovascular aortic repair graft thrombosis for blunt thoracic aortic injury.

Case	Indication for TEVAR	TEVAR and antiplatelet	Time and location of Thrombosis	Presentation	Management	Outcome
Alvarez et al. [6]; 17-year-old male; Spain	High-speed MVC; Aortic rupture distal to the origin of the subclavian artery	Custom (oversizing ×30%) TX2 endovascular graft (Cook Incorporated); ASA 100 mg/day	Time: 11 months; CT–preocclusive thrombosis of the distal portion of the stent	Abdominal pain and paraparesis over his lower extremities	Anticoagulation and antihypertensive therapy.; Right polytetrafluorethylene axillofemoral bypass graft. Open surgical repair with a 20 mm Dacron graft from the ascending aorta to the supraceliac abdominal aorta with removal of the right axillofemoral graft	Asymptomatic 2 years after repair
Marone et al. [8]; 32-year-old male; Italy	High-speed MVC; Posttraumatic 2.5 cm pseudoaneurysm of the aortic isthmus on the lesser curve of the proximal descending thoracic aorta 12 mm distal of the left subclavian artery	Relay Thoracic stent graft (Bolton Medical Inc.); ASA 100 mg/day	Time: 24 months; CT–intragraft atherothrombosis involving the middle and distal third of the aortic stent graft	Asymptomatic and placed on warfarin. Interval progression of size of mural atherothrombosis evolving into multiple intraluminal septa within the aortic stent graft	Failed anticoagulation and converted to open repair with explantation of the aortic stent and reconstruction with a 18 mm Dacron graft	Asymptomatic and well at 3 months
Marino et al. [9]; 38-year-old male; USA	High-speed MVC; Rupture of the aortic isthmus.	Endograft Medtronic Valiant Captivia stent graft VAMF 28 28 C 150 TE; ASA 100 mg/day exchanged for warfarin with finding of thrombus	Time: 6 months; CT #1 (6 months)—thrombus apposition occupying one third of the graft lumen; CT #2 (24 months)—intraluminal thrombus occupied two-thirds of the graft diameter	Asymptomatic. Found on follow-up CT scan	Patient declined open surgery. Redeployment of a conical shape endograft (Medtronic Valiant Captivia stent graft)	Procedure complicated by bilateral distal microembolic lesions at the lower limbs. Treated with low molecular weight heparin infusion. Patient discharged and well at 6 months
Marino et al. [9]; 32-year-old male; USA	High-speed MVC; Traumatic rupture of the aortic isthmus with endograft deployment at the descending thoracic aorta	Relay thoracic stent graft 26 150, (Bolton Medical Inc.); ASA 100 mg/day	Time: 39 months; CT–distal device collapse associated with intragraft thrombus apposition	Refractory headache and buttock claudication	Minimally invasive endovascular treatment. A second conical shape endograft Medtronic Valiant Captivia stent graft VAMC 26 22 C 150 TE	Asymptomatic at 10 months with resolved symptoms
Kumpati et al. [10]; 14-year-old male; USA	High-speed MVC; Aortic rupture of the proximal descending thoracic aorta	Two overlapping ilac limb devices (Medtronic Endurant proximally and Medtronic AneuRx distally); ASA 100 mg/day followed with warfarin for Factor V Leiden	Time: 12 months; CT #1 (12 months)—nonocclusive intraluminal thrombus in the distal portion of the endovascular stent graft; Time: 24 months; CT #2 (24 months)—occlusive thrombus within the distal portion of the stent graft	Scheduled follow-up—asymptomatic with nonocclusive thrombus. Diagnosed with Factor V Leiden and placed on warfarin. Prior ASA; 24 months—discontinued anticoagulation and developed claudication	Factor V leiden. Placed on oral anticoagulation. Discontinued by primary care doctor for patient to play competitive sports.; Heparin for five days and open repair via a left thoracotomy with explantation of the endovascular stent graft. 20 mm Dacron graft from the distal aortic arch to the mid descending aorta	Stable at 6 months on oral anticoagulation
Reich et al. [11]; 24-year-old male; USA	High-speed MVC; Grade IV traumatic transection of the aortic isthmus	talent (Medtronic); ASA 81 mg/daily	Time: 14 months; CT–obstructive thrombus at the distal end of the stent graft	Collapsed while playing basketball	Open descending thoracic aorta replacement. Removal of the previous stent graft using hypothermic circulatory arrest	Paraplegic at 1 year
Abdoli et al. [12]; 29-year-old male; USA	Pedestrian vs. MVC; Grade 3 blunt injury of the descending thoracic aorta and an intra-aortic thrombus extending caudally	Valiant thoracic stent graft (Medtronic) in the middescending thoracic aorta. Proximal extension using a valiant Thoracic Stent graft  mm; ASA 100 mg/day	Time: 9 months; CT–near occlusive thrombosis within the distal portion of the thoracic stent	Sudden painful paresthesia below the waist with swelling of the left foot. Subsequent chest pain, renal failure, and GI bleed	Systemic heparin followed by a right axillobifemoral bypass. Long-term warfarin and aspirin.; Negative coagulopathy work-up	Brief requirement of renal replacement therapy. Planned explantation of endograft. Completing rehab with improving neurological function
Liesdek et al. [13]; 24-year-old-male; Netherlands	High-speed MVC; Traumatic type B aortic dissection (DeBakey type III)	Not stated	Time: 24 months; CT–total occlusion of the thoracic aortic stent graft	Acute complete motoric and sensory loss of both lower limbs while jogging. Development of nausea and vomiting	Emergency surgery to reestablish aortic flow. Left lateral thoracotomy with deep hypothermia. The occluded graft was explanted. Tubular prosthetic graft (24 mm Gelweave, Vascutek Ltd.)	6 months improving neurological status. Patient ambulating with full sensation to his legs
Hostalrich et al. [4]; 15-year-old-female; France	High-speed MVC; Grade 3 blunt thoracic aortic injury just distal to the left subclavian artery	Zenith alpha thoracic stent graft (Cook Incorporated); ASA 100 mg/day	Time: 10 months; CT–near occlusive clot at the distal junction between the thoracic stent graft and the native aorta	Thoracic pain and weakness of the lower limbs. Development of multiorgan dysfunction with pulmonary edema with concurrent anuria	Emergent primary stenting with a bare nitinol stent (OPTIMED ). Treatment with anticoagulation and single antiplatelet	Resolved multiorgan dysfunction. 2 months asymptomatic
Martinelli et al. [14]; Martinelli et al. [15]; 22-year-old-male; Italy	High-speed MVC; Blunt thoracic aortic injury below the isthmus	Zenith Cook  mm (Cook Incorporated) endograft; ASA 100 mg/day	Time: 6 months; CT #1 (6 months)—intimal flap and segmental thrombosis completely occluding the aorta with a valve mechanism; CT #2 (8 months)—recurrent partial occlusion of the distal edge of the second graft	Acute ischemic multiorgan failure and complete bilateral lower extremity motor and sensory loss	Emergency endovascular relining of the endograft using another Zenith Cook  mm device with restoration of perfusion except the spinal cord.; Open conversion with the endograft explanted. The thoracic aorta was replaced with a 22 mm silver-coated graft	Persistent paraplegia
Chiu et al. 2022; 19-year-old-male; Canada	High-speed MVC; Aortic transection injury at the isthmus with pseudoaneurysm	Unknown	Time: 8 months; CT–graft thrombosis with near complete occlusion of the thoracic aortic stent graft	Acute collapse while jogging with complete paraplegia at T8. Multiorgan failure	Emergency systemic and catheter directed tPA followed by aspiration thrombectomy and angioplasty	Death