Mechanical Thrombectomy for the Management of Acute Branch Occlusions in Patients who Previously Underwent Fenestrated/Branched Endovascular Repair for Thoracoabdominal Aneurysm

Abstract

Background: Acute thrombosis of visceral artery branch stents represents a rare but potentially devastating complication among patients who have undergone fenestrated and branched endovascular repair (F/BEVAR) for the treatment of thoracoabdominal aortic aneurysm (TAAA). There is limited data regarding the optimal management strategy in these patients. In this study, we describe the management and outcomes of patients who presented with this complication and were subsequently treated with the use of percutaneous mechanical thrombectomy.

Methods: A retrospective review of all patients enrolled in a single-institution, physician-sponsored investigational device exemption trial for endovascular repair of thoracoabdominal aneurysms (F/BEVAR) from 2012 to 2024 was performed. Patients who presented during the long-term follow-up period with acute graft thrombosis and treated with percutaneous mechanical thrombectomy were identified, and their preoperative course, hospital management, and long-term follow-up are described.

Results: 3 patients (1.3%) were identified with acute mesenteric ischemia or acute kidney injury due to branch graft occlusion and were subsequently treated with percutaneous mechanical thrombectomy. All patients were on a statin and an antiplatelet agent at the time of presentation, and the time from symptom onset to presentation was between 11 hr and 1 week. Patient 1 had complete occlusion of all 4 visceral artery branches. Patient 2 had occlusion of the celiac and superior mesenteric arteries (SMA), and patient 3 had occlusion of the right renal artery. All had successful return of vessel patency following mechanical thrombectomy, with an average fluoroscopy time of 15.5 min. All were spared bowel resection or permanent need for dialysis, and in each of the 7 affected vessels, patency was intact on long-term follow-up.

Conclusion: Percutaneous mechanical thrombectomy represents a viable treatment modality for patients with acute thrombosis of branch stents following F/BEVAR, including those who present in extremis or with multivessel involvement. Given the rapid rate of flow restoration, this technique may represent the optimal treatment modality for this patient population.