A Case of Sudden Death due to Massive Intraluminal Continuous Thrombosis from a Thoracic Stent Graft to Bilateral Femoral Arteries

Abstract

A woman aged 87 underwent root replacement with a mechanical valve and ascending/arch replacement for annuloaortic ectasia with aortic regurgitation and ascending/arch aneurysm 10 years before and thoracic endovascular aortic repair for thoracic descending aneurysm 5 years before. She had been doing well but suffered sudden chest/back pain and bilateral lower-limb paralysis. Contrast-enhanced CT scans revealed filling defects initiating from the distal end of the thoracic stent graft and continuing to the bilateral femoral arteries. Massive thrombosis from the thoracic stent graft to the bilateral femoral arteries was diagnosed. The entire circumference of the thrombus was enhanced, and the thrombus was conceivable not attached to the aortic/arterial inner wall. Although the patient took warfarin orally for the replaced mechanical valve, anticoagulation with heparin was added. Her general condition promptly deteriorated and she died deceased 6 hours after the onset. Thrombosis continuing distally from the thoracic stent graft is extremely rare.