Case Report

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.

CaseIndication for TEVARTEVAR and antiplateletTime and location of ThrombosisPresentationManagementOutcome

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 extremitiesAnticoagulation 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 graftFailed anticoagulation and converted to open repair with explantation of the aortic stent and reconstruction with a 18 mm Dacron graftAsymptomatic 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 scanPatient 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 claudicationMinimally invasive endovascular treatment. A second conical shape endograft Medtronic Valiant Captivia stent graft VAMC 26 22 C 150 TEAsymptomatic 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 basketballOpen descending thoracic aorta replacement. Removal of the previous stent graft using hypothermic circulatory arrestParaplegic 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 bleedSystemic 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 statedTime: 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 vomitingEmergency 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 anuriaEmergent primary stenting with a bare nitinol stent (OPTIMED ). Treatment with anticoagulation and single antiplateletResolved 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 lossEmergency 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
UnknownTime: 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 failureEmergency systemic and catheter directed tPA followed by aspiration thrombectomy and angioplastyDeath