Pulmonary Embolism due to Inferior Vena Cava Compression by a Retroperitoneal Hematoma after Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm

Abstract

We report a case of a patient with a residual hematoma compressing the inferior vena cava after endovascular aneurysm repair (EVAR), which led to a pulmonary embolism (PE). A 65-year-old man underwent emergent EVAR for a ruptured aortic aneurysm in the right retroperitoneal region. He developed sudden chest pain at midnight of the fifth day after EVAR, and computed tomography demonstrated a massive PE. He subsequently went into cardiopulmonary arrest. This case suggested that abdominal complications due to a residual hematoma, including deep vein thrombosis and PE, should be considered in addition to compartment syndrome.

Inferior Vena Cava Compression Caused by a Retroperitoneal Hematoma Following an Abdominal Aortic Aneurysm Rupture

“… 1 , 3 ) IVC compression caused by a retroperitoneal hematoma following an AAA rupture is rare. 3 – 7 ) Ruptured AAAs are lethal vascular events that require prompt diagnosis and treatment. 10 ) Treatments for ruptured AAAs include open surgery and endovascular aneurysm repair (EVAR).…”

“…Previous reports related to IVC compression caused by a retroperitoneal hematoma following AAA ruptures are summarized in Table 1 . 4 – 7 ) Typical symptoms of IVC compression include leg edema, which is typically bilateral and can range from simple premalleolar edema to massive edema involving the thigh and perineum. 3 – 6 ) External compression slows the blood flow velocity in venous vessels, thereby causing IVC thrombosis, DVT, and PTE.…”

“… 3 – 6 ) External compression slows the blood flow velocity in venous vessels, thereby causing IVC thrombosis, DVT, and PTE. 2 – 7 ) In cases of IVC compression caused by a retroperitoneal hematoma following an AAA rupture, venous thromboses can arise, both above and below the site of IVC compression, resulting in IVC occlusion. 4 , 5 ) In this case, the patient did not exhibit leg edema despite postoperative CT scans showing IVC occlusion.…”

“… 1 ) Although abdominal aortic aneurysms (AAAs) can externally compress the IVC, 2 , 3 ) IVC compression caused by a retroperitoneal hematoma following an AAA rupture has been rarely reported to date. 3 – 7 ) Slow blood flow velocity resulting from IVC compression causes IVC thrombosis, deep venous thrombosis (DVT), and pulmonary thromboembolism (PTE). 2 – 7 ) This report presents a case of IVC compression caused by a retroperitoneal hematoma following an AAA rupture.…”

“… 3 – 7 ) Slow blood flow velocity resulting from IVC compression causes IVC thrombosis, deep venous thrombosis (DVT), and pulmonary thromboembolism (PTE). 2 – 7 ) This report presents a case of IVC compression caused by a retroperitoneal hematoma following an AAA rupture.…”