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Aneurysm sac re-expansion after thrombolysis
Abel A Garibaldi1, Zvonimir Krajcer
1Department of Cardiovascular Surgery, Texas Heart Institute and St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
Summary
Delayed re-expansion of abdominal aortic aneurysms (AAA) can occur after thrombolysis. AngioJet thrombectomy may cause AAA sac re-expansion by stripping graft neointima, allowing fluid accumulation.
Area of Science:
- Vascular Surgery
- Interventional Radiology
Background:
- Endovascular aneurysm repair (EVAR) is a common treatment for abdominal aortic aneurysms (AAA).
- Endograft limb occlusion is a potential complication of EVAR, requiring intervention.
- Thrombolysis and thrombectomy are used to treat endograft limb occlusion.
Observation:
- A 68-year-old man with a history of AAA exclusion developed endograft limb thrombosis.
- During AngioJet rheolytic thrombectomy, the patient experienced pain, and the previously stable AAA sac acutely re-expanded.
- The AAA sac resolved spontaneously within one month with conservative management.
Findings:
- AngioJet thrombectomy, using its "power-pulse" spray, may strip the graft's neointima.
- This neointimal stripping can lead to serum accumulation within the AAA sac, causing symptomatic re-expansion.
- Delayed AAA re-expansion is a potential complication of this thrombectomy technique.
Implications:
- Caution is advised when using AngioJet "power-pulse" spray for thrombectomy in thrombosed stent-grafts.
- This technique may increase the risk of AAA sac re-expansion.
- Further research is needed to understand and mitigate this complication.