LATE THROMBOEMBOLIC COMPLICATION FROM A PALMAZ STENT IN THE COMMON ILIAC ARTERY

A 56-year-old smoker presented with rest pain in his left leg and hype rfibrinogenemia. He was found to have a high-grade stenosing thrombus in a Palmaz stent which had been placed 4 years ago across a stenosing ulcerating plaque in the left common iliac artery. Systemic thromboly sis was successful but the patient refused long-term anticoagulation. He presented 2 months later with recurrent stent thrombosis and an emb olus to the tibioperoneal trunk. Systemic lysis was successfully perfo rmed for the stent reobstruction but the distal embolic occlusion resp onded neither to systemic nor to local thrombolysis. This case suggest s that patients with vascular stents and hyperfibrinogenemia and/or ni cotine abuse should be considered candidates for long-term anticoagula tion.