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CC BY 4.0 · Journal of Clinical Interventional Radiology ISVIR
DOI: 10.1055/s-0045-1812286
Case Report

A Case Report of Acute Hemolysis after Endovascular Abdominal Aneurysm Repair with Onyx Embolization of Endoleak: A Clinical Conundrum

Authors

  • Apratim Roy Choudhury 

    1   Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India

  • Jineesh Valakkada

    1   Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India

  • Anoop Ayappan

    1   Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India

  • Ajay Alex

    1   Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India
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Abstract

A 75-year-old gentleman with a large degenerative abdominal aortic aneurysm of diameter 7.5 cm underwent standard endovascular aneurysm repair with Endurant (Medtronic) stent graft. He underwent coil embolization of a small penetrating ulcer in the neck of the aneurysm, followed by liquid embolic agent (Onyx 18) injection in the aneurysm sac in view of endoleak. The procedure was uneventful with <100 mL blood loss. However, in the postoperative period, the patient developed a drop in hemoglobin levels with a rising trend of indirect bilirubin and reticulocyte count—suggestive of acute hemolysis. He was managed conservatively with blood transfusion and recovered well. In this case, the one cause of hemolysis could be mechanical damage to the red blood cells by the bare metal part of the stent and the tortuosity of the iliac vessels. No such previous report of acute hemolysis after aortic stent graft deployment has been previously reported.

Keywords

EVAR - abdominal aortic aneurysms - stent graft - hemolysis

Author Contributions

A.R.C. drafted the article and prepared images. J.V. edited the draft and images, supervised the work, and finalized the manuscript. A.A. contributed valuable inputs in endovascular management of the patient, edited the draft, and reviewed the manuscript. A.j.A. edited and reviewed the manuscript.


Consent for Publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.




Publication History

Article published online:
15 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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