Nonheparin-bonded stent relining in a case of subacute in-stent thrombosis secondary to heparin-induced thrombocytopenia.

A 62-year-old man with incidentally discovered bilateral popliteal artery aneurysms presented with acute critical limb ischemia with a thrombosed popliteal stent, thrombocytopenia, and positive platelet factor 4 antibodies suggesting a diagnosis of type II heparin-induced thrombocytopenia 2 weeks after popliteal artery aneurysm stenting. He was treated with urgent thrombolysis, bivalirudin, and fondaparinux followed by re-intervention with relining of the popliteal artery stents with nonheparin-bonded Viabahn covered stents. At the 6-month follow-up, his platelet count remained above 100,000. He has been successfully transitioned to a direct oral anticoagulant without further complications.