Salvage of EVAR collapse with acute aortic occlusion and paraplegia

Abstract

We present the case of a 61-year-old male who had undergone infrarenal endovascular aortic aneurysm repair, right iliac branched endoprosthesis and left internal iliac artery-covered stenting for aneurysms of the right common iliac artery and left internal iliac artery. Two months after the index procedure, he presented to the emergency room with acute onset of back pain, which progressed to bilateral lower extremity paraplegia and anesthesia. On physical exam, his femoral and pedal pulses were absent. Computed tomography angiography demonstrated collapse of the proximal aortic stent graft with thrombosis of the bilateral common iliac limbs and of the left internal iliac artery stent. He underwent bilateral, over-the-wire Fogarty thrombectomy, 40mm × 10mm Palmaz balloon-expandable stent placement at the proximal endograft, relining of the iliac limbs with covered stents, and aspiration thrombectomy of the left internal iliac artery. Pelvic and lower extremity perfusion were restored at the completion of the procedure. The patient regained motor function on postoperative day 0, and gradually regained sensory function. He was discharged on postoperative day 6 on aspirin (81mg) and low-dose direct oral anticoagulants.

Keywords

• Endograft collapse
• EVAR
• Endovascular aortic aneurysm repair
• Aortic occlusion
• Paraplegia
• Endoleak