Recurrent thoracic aortic stent graft thrombosis

Thoracic aortic mural thrombus is an uncommon but clinically significant source of visceral and peripheral embolization. Endovascular stent grafting is an established treatment; however, recurrent thrombosis within the stent graft in the absence of endoleak, stent migration, technical failure, or hypercoagulable states is rare and poorly understood. We present the case of a 66-year-old man with previous descending thoracic aortic stent graft placement who presented 5 years after the thoracic endovascular aortic repair with epigastric pain and was found to have recurrent aortic and mesenteric thrombosis. He underwent repeat endovascular stent grafting and superior mesenteric artery thrombectomy. Postoperative imaging demonstrated appropriate stent graft position without endoleak or mechanical complication. An initial hematologic evaluation, including Janus kinase 2 V617F mutation testing and paroxysmal nocturnal hemoglobinuria flow cytometry, was unrevealing, although the workup was incomplete due to loss of follow-up. This case highlights the rare occurrence of late thoracic endograft thrombosis following treatment of nontraumatic descending thoracic aortic thrombus.