Catastrophic outcome of de novo aortic thrombus after stent grafting for blunt thoracic aortic injury.

Fourteen months after thoracic endovascular aortic repair for blunt thoracic aortic injury, a 24-year-old man abruptly collapsed. His neurologic function in the lower extremities fluctuated. Subsequent computed tomography (CT) demonstrated a nearly occlusive thrombus within his aortic stent. He underwent open descending thoracic aortic replacement. This dramatic case is the first report of spontaneous intraluminal thrombosis in an intact stent graft, as well as the first report of waxing and waning symptoms of spinal cord ischemia resulting from nearly obstructive thrombus. Stent graft thrombus is a potential complication after endovascular repair for traumatic aortic injury and is an additional consideration when weighing the risks and benefits of endovascular repair and subsequent surveillance strategies.