LAUSR

INTRODUCTION We report a rare case of delayed, symptomatic thoracic endograft thrombosis after the initial TEVAR for blunt thoracic aortic injury (BTAI) which was successfully retreated with a redo TEVAR, followed by open conversion due to recurrent partial occlusion of the distal edge of the endografts. METHODS Two years ago, a 22-year-old man had undergone an emergency TEVAR for BTAI. A Zenith Cook 22 x 100 mm (Cook Incorporated, Bloomington, IN) endograft was used. Six months later he underwent an emergency endovascular relining of the endograft using the same type of device. The multi-organ perfusion was completely restored except for the spinal cord injury. After eight months a recurrent partial occlusion of the distal edge of the second graft was documented. The thoracic aorta was replaced with a 22-mm silver coated graft (Maquet Spain, S.L.U.). Histology exam showed a neointimal formation, thickening and fibrosis of the inner 1/3 of the media with loss of smooth muscle cells and increase of the elastic fibers. CONCLUSION The need of secondary interventions or open conversion due to potential complications after TEVAR for traumatic aortic injury is an additional consideration when weighing the risks and benefits of endovascular repair and subsequent surveillance strategies.