AAA Endograft Clot

Physicians

Anthony Comerota, M.D.
Robert DiSalle, M.D.
Jobst Vascular Center/Toledo Hospital,
Toledo, OH

Background

A 78 year old male presented with acute left leg ischemia due to acute thrombosis of the left limb of his aortic stent graft, which was inserted two weeks prior for a 6.5cm abdominal aortic aneurysm (AAA). Arteriography confirmed thrombosis of the left limb of the aortic endograft (Figure 1).

Isolated pharmacomechanical thrombolysis was suggested for the occluded left limb of the endograft in order to restore patency and identify and correct the reason for graft limb thrombosis.

Procedure

The left femoral artery was accessed utilizing an 8Fr sheath. An 80cm x 15cm treatment zone Trellis®-8 Peripheral Infusion System was placed in the left iliac portion of the endograft (Figure 2).

A dose of 4mg of t-PA was administered followed by a 10-minute device run time. Post-treatment arteriography demonstrated complete thrombus removal. The distal aspect of the graft had a significant kink causing narrowing of the outflow of the left limb of the graft.

Angioplasty and stenting were then performed to attempt straightening of the vessel tortuosity observed distal to the AAA endograft (Figure 3). An 8mm nitinol stent was then placed from the distal aspect of the left limb of the endograft extending into the left external iliac artery to eliminate the kink.

Completion arteriography demonstrated a patent graft with no residual stenosis and perfusion to the left leg (Figure 4).

Conclusion

Isolated pharmacomechanical thrombolysis using the Trellis-8 device rapidly restored patency of the thrombosed left limb of the aortic endograft via single-setting treatment. The device also provided protection from distal embolization via the device's dual occlusion balloons. The underlying problem, of a graft kink with stenosis, was quickly identified and corrected, restoring normal perfusion to the left leg.