Regional Thrombolytic Therapy and Stent Implantation in an Acutely Occluded Aortobifemoral Bypass Graft

Abstract

Based on this patient's response, local thrombolysis followed by stenting may be a safe and effective alternative to reoperation for the treatment of acute graft thrombosis caused by an intimal aortic flap. More experience with this approach is necessary to determine if this is an acceptable and effective mode of treatment.

Percutaneous Endovascular Recanalization of a Thrombosed Aortic Graft Limb with Stent Placement

“…Since major complications related to either catheter-directed thrombolytic therapy or an open-surgery approach are avoided, the endovascular approach seems attractive and feasible not only in early-or late-postoperative occlusions, but also in cases of acute ischemia, where the prolonged thrombolysis cannot be tolerated [8,9]. Generally, in aortoiliac failed grafts, angioplasty and/or stent placement follows catheter-directed thrombolysis, aspiration thrombectomy, or other clot removal methods, preceding stenting that aims mainly at correcting an anastomotic failure [10].…”

Aortoenteric fistula as a late complication of thrombolysis and bare metal stenting for perioperative occlusion of aortofemoral bypass

“…We previously reported a case of acute thrombosis of aortofemoral bypass graft in the same patient, treated with regional thrombolysis followed by stenting of an infrarenal aortic intimal flap with a Palmaz balloon-expandable stent. 2 We described this endovascular approach as a feasible alter- native treatment in selected cases to avoid the high mortality and amputation rates associated with surgical reoperation, 8 reducing operative risk.…”

“…Now, we would consider the endovascular treatment we performed and published in 2003 to be unsafe. 2 We assessed this case to be prone to all the main risk factors for development of late aortoenteric fistula, related to the aortic endarterectomy, the thrombolysis, and the aortic stenting.…”

“…1 Although surgical thrombectomy is considered standard treatment in these cases, an endovascular approach to graft occlusion can be used to reduce the risk of reoperation. 2 Intra-arterial selective thrombolysis and stenting have been previously reported to be feasible in perioperative graft occlusion without significant early complications, such as bleeding, from the recently scarred tissues and the arterial anastomoses. 2,3 Long-term results of this alternative technique have not been reported, and the risk of late complications should be carefully considered and reported in the literature.…”

“…2 Intra-arterial selective thrombolysis and stenting have been previously reported to be feasible in perioperative graft occlusion without significant early complications, such as bleeding, from the recently scarred tissues and the arterial anastomoses. 2,3 Long-term results of this alternative technique have not been reported, and the risk of late complications should be carefully considered and reported in the literature. We report a case of aortoenteric fistula that occurred 6 years after a successful intra-arterial thrombolysis and aortic stenting for perioperative occlusion of an aortofemoral expanded polytetrafluoroethylene (ePTFE) bypass graft.…”