Chronic complete thrombosis of abdominal aortic aneurysm: An unusual presentation of an unusual complication

Abstract

Although mural thrombosis frequently accompanies aneurysmal disease, complete thrombosis is distinctly unusual complication of abdominal aortic aneurysm (AAA). A case study of a patient with chronic, asymptomatic complete thrombosis of a large juxtarenal AAA is presented along with a literature review and discussion of the potential secondary complications, mandating aggressive management of this condition. A 67-year-old man with multiple atherogenic risk factors and unattended complaints consistent with a recent episode of a transient right hemispheric ischemic attack was referred to our clinic with a diagnosis of a thrombosed AAA established by computed tomography. Duplex ultrasonography and aortography confirmed the referral diagnosis and also revealed near occlusion of the left internal carotid artery. The patient underwent a two-stage surgery, with preliminary left-sided carotid endarterectomy followed three days later by an aneurysmectomy and aortobifemoral reconstruction. He had an uncomplicated recovery and was discharged home on postoperative day 7, remaining asymptomatic at the 42-month follow-up. Complete thrombosis is an uncommon presentation of AAA and may be clinically silent. It is frequently associated with other manifestations of generalized atherosclerosis. Radical open repair yields durable result and is the preferred treatment modality.

Lipoprotein(a) Levels in Patients With Abdominal Aortic Aneurysm

“…5 The pathophysiology of the development of AAAs is complex and not completely understood; the risk of AAA formation correlates with atherosclerosis and thrombosis. 3,6,7 Lipoprotein(a), Lp(a), consists of a low-density lipoprotein (LDL)-like lipoprotein and apolipoprotein(a), apo(a): a glycoprotein, covalently linked via a disulfide bond. 8,9 Its LDL-like properties promote atherosclerosis, and its plasminogen-like apo(a) properties promote thrombosis by interfering with fibrinolysis.…”

“…5 The pathophysiology of the development of AAAs is complex and not completely understood; the risk of AAA formation correlates with atherosclerosis and thrombosis. 3,6,7…”