The use of an anti-fibrinolytic agent to reduce endoleak following endovascular repair of multiple aortic aneurysms.

This paper reports on the therapeutic use of tranexamic acid in an elderly patient with severe comorbidities that precluded even endovascular reintervention. Orally administered tranexamic acid mitigated and partially reversed two and a half years of progressive aneurysmal expansion and closed a persistent endoleak after thoracic endovascular aneurysm repair and endovascular aneurysm repair for coexisting lesions. Reappearance of the endoleak when tranexamic acid was accidentally stopped and its re-closure after the resumption of tranexamic acid treatment confirmed causality. This singular experience extends prior published observations that administration of prophylactic tranexamic acid before thoracic endovascular aneurysm repair and endovascular aneurysm repair resulted in significantly greater shrinkage, particularly if an endoleak or coagulopathy was present.