A Floating Thrombus Anchored at the Proximal Anastomosis of a Woven Thoracic Graft Mimicking a Genuine Aortic Dissection.

Abstract

An aortoesophageal fistula following surgery for a ruptured 6.6-cm thoracic aneurysm in a 69-year-old female was repaired using a 34-mm woven prosthetic graft. A follow-up computed tomography (CT) scan at 10 days postoperatively revealed a dissection-like picture in the region of the graft, which was treated conservatively. The patient eventually died from sepsis and multiorgan failure. At autopsy, the graft was retrieved in situ and studied by detailed gross, microscopy, and scanning electron microscopy (SEM) examination. Gross observation confirmed that the dissection resulted from the rolling of the internal capsule downstream. A massive thrombus anchored at the proximal anastomosis and held by a narrow head was also noted. The thrombus demonstrated reorganization in the area of the anastomosis, with a false lumen in its distal half. The reminder of the thrombus consisted of layered fibrin. After gross examination, the fabric graft was found to be flawless. Additional detailed studies were also done using microscopy, SEM, and gross examination.

• Authors: Bin Li, Bing Liu, Yijun Fu, Olexandr Bondarenko, Alain Verdant, Olivier Rochette-Drouin, Jing Lin, Jean-Michel Bourget, Randolph Guzman, Lu Wang, Ze Zhang, Yvan Douville, Lucie Germain, Zaiping Jing, Robert Guidoin
• Journal: Journal of long-term effects of medical implants (J Long Term Eff Med Implants) Vol. 25 Issue 3 Pg. 179-200 ( 2015) ISSN: 1940-4379 [Electronic] United States
• PMID: 26756557 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Anastomosis, Surgical (adverse effects)
• Aortic Dissection (diagnostic imaging)
• Aorta, Thoracic (diagnostic imaging, surgery)
• Blood Vessel Prosthesis (adverse effects)
• Fatal Outcome
• Female
• Humans
• Microscopy, Electron, Scanning
• Thrombosis (diagnostic imaging, etiology, pathology)
• Tomography, X-Ray Computed