Persistent disseminated intravascular coagulation despite correction of endoleaks after thoracoabdominal endovascular...

Area of Science:

• Vascular Surgery
• Hematology
• Critical Care Medicine

Background:

• Disseminated intravascular coagulation (DIC) is a rare but serious complication following endovascular aortic repair (EVAR).
• DIC is characterized by excessive thrombin generation, leading to consumption of coagulation factors and platelets, resulting in bleeding or thrombosis.
• Type I or III endoleaks are commonly associated with post-EVAR DIC.

Observation:

• An 80-year-old woman developed recurrent DIC after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection.
• The patient required multiple TEVAR extensions to manage the thoracoabdominal aorta due to recurrent endoleak-induced DIC.
• DIC persisted despite successful resolution of endoleaks.

Findings:

• This case demonstrates a persistent DIC that was not resolved by addressing the endoleaks.
• Recurrent DIC can occur in complex aortic dissections treated with TEVAR, posing significant management challenges.
• The underlying mechanisms of persistent DIC in this context warrant further investigation.

Implications:

• Management of post-EVAR DIC may require strategies beyond endoleak repair.
• Further research is needed to understand and manage persistent DIC after complex aortic interventions.
• This case underscores the importance of vigilant monitoring for coagulopathy in patients undergoing TEVAR.