Pathological fibrinolysis secondary to pseudoaneurysms

Area of Science:

• Vascular Surgery
• Hematology
• Coagulation Disorders

Background:

• Aortobifemoral bypass grafts are used to treat peripheral artery disease.
• Maintaining a balance between coagulation and fibrinolysis is crucial for hemostasis.
• Pathological fibrinolysis involves excessive clot breakdown, leading to bleeding risks.

Observation:

• A patient developed a pulsatile abdominal mass and leg ischemia four years post-aortobifemoral bypass.
• Excessive bleeding and abnormal coagulation screening suggested pathological fibrinolysis.
• The coagulopathy was linked to pseudoaneurysms, a rare complication.

Findings:

• Coagulation screening revealed rapid clot lysis, elevated fibrin split products, and low fibrinogen.
• Treatment with epsilon-aminocaproic acid (EACA) temporarily controlled the bleeding.
• Resection of the pseudoaneurysms successfully resolved the pathological fibrinolysis.

Implications:

• Pseudoaneurysms should be considered in the differential diagnosis of coagulopathy after bypass surgery.
• This case highlights a novel complication of pseudoaneurysms involving pathological fibrinolysis.
• Understanding this link may improve patient management and outcomes in vascular surgery patients.