Pulmonary embolism (PE) that occurs in patients with severe chronic obstructive pulmonary disease (COPD) can often result in acute exacerbation. Immediate intervention for them is required to prevent acute exacerbations and reduce mortality. A 72-year-old man with severe COPD developed deep vein thrombosis with PE and worsened despite anticoagulant therapy and mechanical ventilation. Thrombolysis was contraindicated due to a history of gastric bleeding 3 weeks ago. He had a pulmonary embolism severity index (PESI) score of 272, placing him in the very high-risk group, with a 30-day mortality rate of 10.0%–24.5%. Mechanical thrombectomy was performed using AngioJet® Solent catheter to remove the thrombus obstructing the right middle and lower lobe pulmonary arteries. The patient improved without complications and was discharged. PE in severe COPD requires immediate intervention due to the higher severity of symptoms compared to the general population, and the use of AngioJet ® Solent catheter may be an effectively alternative modality of treatment.

Addressing the high incidence of late type III endoleaks in previous AFX models, Endologix upgraded the device material and updated its recommendation regarding component overlap. However, whether upgraded AFX2 models are safe for endoleaks remains controversial. Here we report a case of a 67-year-old male with an AFX2-implanted abdominal aortic aneurysm experiencing a delayed type IIIa endoleak. Aneurysmal sac enlargement occurred 36 months post-endovascular aneurysm repair (EVAR), with a computed tomography scan at 52 months revealing component overlap loss and a significant type IIIa endoleak. We performed endograft explantation and endoaneurysmal aorto-bi-iliac interposition grafting.Our findings suggest that sufficient component overlap is necessary when using an AFX2 endograft outside the manufacturer’s instructions for use to prevent late type IIIa endoleaks. Moreover, patients who undergo EVAR with AFX2 for tortuous large aortic aneurysms should be carefully monitored for conformational changes.