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Aneurysm expansion and retroperitoneal hematoma after thrombolysis for stent-graft limb occlusion caused by distal endograft migration

Resch, Tim LU ; Lindblad, Bengt LU ; Lindh, Mats LU ; Brunkwall, Jan and Ivancev, Krassi LU (2000) In Journal of Endovascular Therapy 7(6). p.446-446
Abstract
PURPOSE: To describe a complication of thrombolytic therapy used to treat graft limb occlusion precipitated by distal migration and kinking of an abdominal aortic stent-graft. CASE REPORT: A 5.5-cm abdominal aortic aneurysm (AAA) in a 66-year-old woman was treated with Vanguard bifurcated stent-graft. At the 1-year follow-up, she complained of left leg claudication. Computed tomography (CT) showed a 36% reduction in maximum AAA diameter, but the stent-graft had migrated distally approximately 5 mm, and the left graft limb was occluded. Thrombolysis was initiated, but after approximately 8 hours, abdominal pain began. Emergent CT scanning revealed rapid aneurysm expansion and a retroperitoneal hematoma. Thrombolytic treatment was stopped;... (More)
PURPOSE: To describe a complication of thrombolytic therapy used to treat graft limb occlusion precipitated by distal migration and kinking of an abdominal aortic stent-graft. CASE REPORT: A 5.5-cm abdominal aortic aneurysm (AAA) in a 66-year-old woman was treated with Vanguard bifurcated stent-graft. At the 1-year follow-up, she complained of left leg claudication. Computed tomography (CT) showed a 36% reduction in maximum AAA diameter, but the stent-graft had migrated distally approximately 5 mm, and the left graft limb was occluded. Thrombolysis was initiated, but after approximately 8 hours, abdominal pain began. Emergent CT scanning revealed rapid aneurysm expansion and a retroperitoneal hematoma. Thrombolytic treatment was stopped; transfusions and thrombogenic drugs were given to restore hemodynamic stability. The aneurysm began to decrease in size. The occluded graft limb had been reopened by the lytic therapy, uncovering a stenosis in the native artery distal to the graft limb. Stent placement restored outflow. The retroperitoneal hematoma resolved over time, and the aneurysm sac shrank to its prelytic diameter. The patient is well with a functioning endograft 18 months after the occlusion (30 months after stent-grafting). CONCLUSIONS: Caution must be taken when using thrombolysis in patients with endovascular aortic grafts because unexpected bleeding complications might arise. Thrombectomy, femorofemoral bypass, or stent or stent-graft extensions might be safer alternatives for treating occluded stent-graft limbs. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Endovascular Therapy
volume
7
issue
6
pages
446 - 446
publisher
International Society of Endovascular Specialists
external identifiers
  • pmid:11194815
  • scopus:0034522163
ISSN
1545-1550
DOI
10.1583/1545-1550(2000)007<0446:AEARHA>2.0.CO;2
language
English
LU publication?
yes
id
01a00bf0-16d2-42c4-a73b-3fcba82d26a6 (old id 1118081)
date added to LUP
2008-06-24 14:15:56
date last changed
2017-01-01 04:46:51
@article{01a00bf0-16d2-42c4-a73b-3fcba82d26a6,
  abstract     = {PURPOSE: To describe a complication of thrombolytic therapy used to treat graft limb occlusion precipitated by distal migration and kinking of an abdominal aortic stent-graft. CASE REPORT: A 5.5-cm abdominal aortic aneurysm (AAA) in a 66-year-old woman was treated with Vanguard bifurcated stent-graft. At the 1-year follow-up, she complained of left leg claudication. Computed tomography (CT) showed a 36% reduction in maximum AAA diameter, but the stent-graft had migrated distally approximately 5 mm, and the left graft limb was occluded. Thrombolysis was initiated, but after approximately 8 hours, abdominal pain began. Emergent CT scanning revealed rapid aneurysm expansion and a retroperitoneal hematoma. Thrombolytic treatment was stopped; transfusions and thrombogenic drugs were given to restore hemodynamic stability. The aneurysm began to decrease in size. The occluded graft limb had been reopened by the lytic therapy, uncovering a stenosis in the native artery distal to the graft limb. Stent placement restored outflow. The retroperitoneal hematoma resolved over time, and the aneurysm sac shrank to its prelytic diameter. The patient is well with a functioning endograft 18 months after the occlusion (30 months after stent-grafting). CONCLUSIONS: Caution must be taken when using thrombolysis in patients with endovascular aortic grafts because unexpected bleeding complications might arise. Thrombectomy, femorofemoral bypass, or stent or stent-graft extensions might be safer alternatives for treating occluded stent-graft limbs.},
  author       = {Resch, Tim and Lindblad, Bengt and Lindh, Mats and Brunkwall, Jan and Ivancev, Krassi},
  issn         = {1545-1550},
  language     = {eng},
  number       = {6},
  pages        = {446--446},
  publisher    = {International Society of Endovascular Specialists},
  series       = {Journal of Endovascular Therapy},
  title        = {Aneurysm expansion and retroperitoneal hematoma after thrombolysis for stent-graft limb occlusion caused by distal endograft migration},
  url          = {http://dx.doi.org/10.1583/1545-1550(2000)007<0446:AEARHA>2.0.CO;2},
  volume       = {7},
  year         = {2000},
}