Adverse outcome following transfemoral endovascular stent-graft repair of an abdominal aortic aneurysm in a patient with severe liver dysfunction: Report of a case

Abstract

We describe herein the case of a patient with severe liver failure in whom an abdominal aortic aneurysm (AAA) extending to the right iliac artery was diagnosed. Because the risk of performing a standard open repair was considered too high in this patient, the aneurysm was uneventfully repaired using a technique of transfemoral endovascular stent-grafting with femorofemoral bypass and occlusion of the left common and right internal iliac arteries. Unfortunately, multiorgan failure associated with adult respiratory distress syndrome (ARDS) and disseminated intravascular coagulation (DIC) suddenly developed on postoperative day (POD) 2 and the patient died on POD 9. Thus, although endovascular stent-grafting is generally assumed to be less invasive and therefore feasible for high-risk patients, patients with severe liver dysfunction may not be suitable candidates.

Changes in thrombin generation, fibrinolysis, platelet and endothelial cell activity, and inflammation following endovascular abdominal aortic aneurysm repair

“…25,26 It has been suggested that continued perfusion of a thrombus-filled aneurysm sac might predispose to an acute-onchronic consumptive coagulopathy. 27,28 The present study confirms that patients with asymptomatic AAA exhibit a prothrombotic diathesis characterized by excessive thrombin generation as shown by markedly elevated PF1 ϩ 2 and TAT prior to EVAR.…”

The impact of endograft type on inflammatory response after endovascular treatment of abdominal aortic aneurysm

“…Cases of disseminated intravascular coagulopathy after EVAR have been described. 18,19 A recent study showed that a prothrombotic, hypofibrinolytic diathesis associated with AAAs may be normalized after EVAR, Fig. (Continued) providing a beneficial systemic effect of EVAR for AAA disease that may protect patients against future thromboembolic cardiovascular events.…”

An Unusual Complication of EVAR, Spontaneous Rectus Sheath Hematoma: A Case Report

“…10) Very few cases of consumptive coagulopathy following treatment with EVAR have been reported in literatures. 11,12) In the presented case, the pre-operative and post-operative coagulation studies were normal and we thought the spontaneous hemorrhage of the abdominal wall was caused by prophylactic anticoagulation therapy, which was initiated in order to provide patency of the implanted aortic stent graft. Additionally, to the best of our knowledge, this complication due to anticoagulation therapy following EVAR has not been reported previously.…”