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

## TL;DR

A rare case of chronic left renal artery occlusion due to extensive mural thrombus in a patient with a history of abdominal aortic aneurysm repair highlights the need for lifelong surveillance.

## Contribution

This case emphasizes the clinical significance of mural thrombus formation and the importance of long-term monitoring in EVAR patients.

## Key findings

- A 75-year-old female with a history of EVAR developed extensive mural thrombus leading to left renal artery occlusion.
- Thrombus formation was likely influenced by metastatic lung cancer and endograft configuration.
- The case advocates for lifelong annual surveillance using imaging modalities to detect complications.

## Abstract

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.