A ruptured aneurysm after stent graft puncture during computed tomography-guided thrombin injection

Abstract

Type II endoleaks occur in 5% to 10% of patients who are treated by endovascular aneurysm repair. A persistent type II endoleak combined with documented aneurysm expansion is generally considered an indication for intervention. Thrombin injection directly into the aneurysm sac is described as a safe and efficient treatment option. We present a patient with a ruptured aneurysm caused by a puncture of the stent graft during computed tomography-guided thrombin injection. This case highlights a possible harmful complication of thrombin injection and emphasizes the need for caution while performing such a procedure.

Lack of thrombus organization in nonshrinking aneurysms years after endovascular abdominal aortic aneurysm repair

“…Approximately 300 mL of blood was aspirated from the aneurysm sac, confirming the presence of unorganized thrombus. 22 In two patients, more than 70% of the aneurysm sac consisted of unorganized thrombus. The average aneurysm sac volume of all patients was 167 Ϯ 107 mL.…”

Annual rupture risk of abdominal aortic aneurysm enlargement without detectable endoleak after endovascular abdominal aortic repair

“…35,36 For most patients, however, the mortality risk of a conversion seems higher than the risk of rupture, and a percutaneous translumbar puncture of the aneurysm sac also carries a small risk for complications. 37 Considering the results and reports above, we advise a conservative policy up to the first 4 years for patients at low-risk of rupture instead of conversion to open AAA repair for those with aneurysm enlargement without imaging-detected endoleaks.…”

A case of hybrid repair of ruptured abdominal aortic aneurysm with use of thrombin for acute treatment of type II endoleak

“…Ultrasound-guided injection into a large AAA and left common iliac artery aneurysm sac lowers the risk of inadvertent injury to the endograft, as has been reported in the case of CT-guided injection. 13 Thrombin injection under realtime ultrasound guidance can limit the volume of the drug necessary to induce thrombosis. By injecting the medication under low pressure in the anterior segment of the sac, this may lower the possibility of the drug entering the lumbar vessels, which could result in spinal cord ischemia.…”