Aneurysm expansion and retroperitoneal hematoma after thrombolysis for stent-graft limb occlusion caused by distal endograft migration

Purpose: To describe a complication of thrombolytic therapy used to treat g raft limb occlusion precipitated by distal migration and kinking of an abdo minal aortic stent-graft. Case Report: A 5.5-cm abdominal aortic aneurysm (AAA) in a 66-year-old woma n was treated with Vanguard bifurcated stent-graft. At the 1-year follow-up , she complained of left leg claudication. Computed tomography (CT) showed a 36% reduction in maximum AAA diameter, but the stent-graft had migrated d istally approximately 5 mm, and the left graft limb was occluded. Thromboly sis was initiated, but after approximately 8 hours, abdominal pain began. E mergent CT scanning revealed rapid aneurysm expansion and a retroperitoneal hematoma. Thrombolytic treatment was stopped; transfusions and thrombogeni c drugs were given to restore hemodynamic stability. The aneurysm began to decrease in size. The occluded graft limb had been reopened by the lytic th erapy, uncovering a stenosis in the native artery distal to the graft limb. Stent placement restored outflow. The retroperitoneal hematoma resolved ov er time, and the aneurysm sac shrank to its prelytic diameter. The patient is well with a functioning endograft 18 months after the occlusion (30 mont hs after stent-grafting). Conclusions: Caution must be taken when using thrombolysis in patients with endovascular aortic grafts because unexpected bleeding complications might arise. Thrombectomy, femorofemoral bypass, or stent or stent-graft extensi ons might be safer alternatives for treating occluded stent-graft limbs.