Endovascular treatment of an acutely thrombosed AAA

To report a case of lower extremity ischemia due to acute thrombosis of an abdominal aortic aneurysm (AAA) that was successfully treated with emergent stent-graft placement.

A 58-year-old hypertensive man was transferred from an outside hospital with the history of sudden onset of pain, paresis, and purple discoloration of both lower extremities extending up to the umbilicus. Femoral and distal pulses were absent on examination. Contrast-enhanced computed tomography showed a 3.8-cm infrarenal AAA with a large thrombus occluding the bifurcation of the iliac arteries. The patient was treated emergently with an AneuRx stent-graft that excluded the thrombus and the AAA from the circulation, with return of distal pulsation and recovery of ischemic and neurological deficits. At 10-month follow-up, the patient remained asymptomatic.

Selected cases of acute thrombosis of AAA with favorable anatomy can be treated utilizing endovascular grafts. Extra precaution should be taken to prevent embolization during catheter manipulation and introduction of the large stent-graft devices.