Recurrent Thoracic Aortic Stent Graft Thrombosis

Thoracic aortic mural thrombus is an uncommon but clinically significant source of visceral and peripheral embolization. Endovascular stent grafting is an established treatment; however, recurrent thrombosis within the stent graft in the absence of endoleak, stent migration, technical failure, or hypercoagulable states is rare and poorly understood. We present a 66-year-old male with prior descending thoracic aortic stent graft placement who presented 5 years after TEVAR with epigastric pain who was found to have recurrent aortic and mesenteric thrombosis. He underwent repeat endovascular stent grafting and superior mesenteric artery thrombectomy. Post operative imaging demonstrated appropriate stent graft position without endoleak or mechanical complication. An initial hematologic evaluation, including JAK2 V617F and PNH flow cytometry, was unrevealing, though the workup was incomplete due to loss of follow up. This case highlights the rare occurrence of late thoracic endograft thrombosis following treatment of nontraumatic descending thoracic aortic thrombus.