Eur J Cardiothorac Surg 2002;22:628
© 2002 Elsevier Science NL
Images in cardio-thoracic surgery |
Mural thrombosis in thoracic aortic stent-graft
Robin H. Heijmen*,
Marc A.A.M. Schepens
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
Received 25 May 2002;
received in revised form 7 June 2002;
accepted 13 June 2002.
* Corresponding author. Tel.: +31-30-609-2047; fax: +31-30-609-2120
e-mail: rheijmen{at}hetnet.nl
Key Words: Mural thrombosis • Thoracic aorta • Stent graft
Routine computed tomography (CT) scanning, 1 year after endovascular treatment of a saccular, descending thoracic aortic aneurysm with an Excluder stent-graft (internally covered with polytetrafluoroethylene (PTFE)) (Fig. 1)
, revealed intraluminal thrombus formation along its length and circumference (Fig. 2A,B)
, despite antiplatelet therapy (acetylsalicylic acid). No hereditary coagulation disorder is known in this patient. Although previously described in abdominal bifurcated stent-grafts, it is an unreported finding in the thoracic aorta.
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Fig. 1. Intraoperative digital subtraction angiogram of a saccular, mid-descending thoracic aortic aneurysm which has been successfully excluded using a 200-mm-long Excluder stent-graft (diameter 40 mm). At the site of the aneurysm, the stent-graft bulges slightly without kinking.
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Fig. 2. Contrast-enhanced CT scan of the descending thoracic aorta demonstrating complete exclusion of the aneurysm (diameter 60 mm) by the stent-graft. Surprisingly, however, a large eccentric mural thrombus was observed in the Excluder stent-graft, consisting of a self-expanding Nitinol stent internally covered with a PTFE graft (A). The thrombus continued distally along its full circumference (B).
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