Delayed Migration of a Thrombosed Aortic Endograft Within a Thrombosed Aneurysm Sac Resulting in Continued Sac Expansion and Rupture

Abstract

We present the case of delayed migration of a thrombosed aortic endograft within a thrombosed aneurysm sac that expanded and ruptured. Dilation of the aortic neck likely led to endograft migration and exposure of the occluded endograft and aneurysm sac to systemic pressure. Although no endoleak was identified, a key finding on ultrasound showed mobility of the sac thrombus. This may be an indicator of flow within the sac that may predict potential for rupture. Despite thrombosis of the aortic sac and endograft, the risk of rupture still lingers, and thus continued surveillance of occluded endografts may be prudent. (J Vasc Surg Cases and Innovative Techniques 2017;3:115-8.) Endovascular aneurysm repair (EVAR) is the standard of care for abdominal aortic aneurysms (AAAs). Early landmark trials showed increased reintervention rate and late mortality secondary to late rupture in the EVAR group.

Endovascular Solution to Endoleak Phenomenon After Open Repair of Abdominal Aortic Aneurysm

“…Different densities of the thrombus may have significant implications to the etiology of these endoleaks and why some thrombose and others do not. 17,18 Akin to late endoleaks after EVAR, it is still unclear why some thrombus is vulnerable to dissolution and allows inflow channels to open. Long-term surveillance to assess thrombus quality in already repaired aneurysms has been previously described.…”

“…Long-term surveillance to assess thrombus quality in already repaired aneurysms has been previously described. 17…”