Recanalization of previously thrombosed type II endoleak with aneurysm sac expansion after systemic thrombolysis

Patients who have undergone endovascular aneurysm repair (EVAR) need lifelong monitoring because of the risk of aneurysm rupture secondary to delayed endoleaks. Thrombolytic therapy may expose patients with previous EVAR to the risk for development of new endoleaks. We describe a case in which a single dose of intravenous tissue plasminogen activator for acute ischemic stroke was complicated by aneurysm sac expansion secondary to a recurrent endoleak. The potential for a life-threatening complication may warrant routine imaging evaluation of the stent graft after systemic tissue plasminogen activator therapy for acute ischemic stroke in patients with previous EVAR.