Left Renal Artery Chronic Occlusion in the Setting of Extensive Intraprosthetic Mural Thrombus in an Abdominal Aortic Endograft

Thrombotic deposits within aortic endograft post-endovascular aortic aneurysm repair (EVAR) is a fairly well-recognized complication, yet their clinical significance remains inadequately understood. We present a rare case of extensive mural thrombus formation in an oncologic patient with a history of EVAR, emphasizing the importance of lifelong surveillance in abdominal aortic aneurysm (AAA)-EVAR patients. A 75-year-old female was admitted with refractory hypertension secondary to a medium-sized AAA, which exhibited an extensive mural thrombus, contributing to atrophic changes in the left kidney and likely chronic occlusion of the left renal artery. Factors contributing to thrombus formation generally include endograft configuration, aneurysm diameter, and patient-specific characteristics, such as a pro-thrombotic status conferred by metastatic lung cancer. This case underscores the necessity for comprehensive surveillance strategies post-EVAR. Recommendations advocate for a 30-day follow-up and lifelong annual surveillance, employing modalities such as color duplex ultrasound for detection of endoleaks and sac enlargement, with selective use of CT imaging. This case underscores the importance of continued vigilance and surveillance in patients undergoing EVAR, particularly those with complex medical histories, to mitigate potential long-term complications and optimize patient outcomes.