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International Angiology 1998 December;17(4):241-3


lingua: Inglese

Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report

Lindholt J. S., Sandermann J., Bruun-Petersen J. *, Nielsen J. O. D. **, Fasting H.

From the Vascular Surgical Unit, * Department of Radiology, ** Department of Anaestesiology, Viborg Hospital, Viborg, Denmark


Background. The short term expe­ri­ence of endo­vas­cu­lar treat­ment of abdom­i­nal aor­tic aneu­rysms (AAA) seems prom­is­ing but long term ran­dom­ised data are lack­ing. Consequently, cases treat­ed by endo­vas­cu­lar pro­ce­dures need to be close­ly fol­lowed for poten­tial risks and ben­e­fits.
Case ­report. A 70 year-old mild­ly hyper­ten­sive male with­out pre­vi­ous or ­present arte­rio­scle­rot­ic, pul­mo­nary, or uro­log­i­cal man­i­fes­ta­tions was sub­ject­ed to endo­vas­cu­lar treat­ment after his mass-screen­ing diag­nosed abdom­i­nal aor­tic aneu­rysm had expand­ed to above 5 cm in diam­e­ter, the aneu­rysm hav­ing been found by CT-scan­ning and arter­i­og­ra­phy to be endo­vas­cu­lar­ly treat­able. A Vanguard bifur­cat­ed aor­tic stent graft was implant­ed under epi­du­ral/spi­nal anaesthe­sia and cov­ered by ceph­a­los­po­rine and hep­ar­in (8000 IE) pro­tec­tion. Apart from treat­ment of a groin hae­mat­o­ma and sten­o­sis of the left super­fi­cial femo­ral ­artery, the post­op­er­a­tive peri­od pre­sent­ed no prob­lems. A few days ­before the month­ly fol­low-up visit, the ­patient devel­oped urae­mia, gan­grene of one foot and dysp­noea. Blood glu­cose and LDH was ele­vat­ed. Deterio-ration led to death a month and a half after stent implan­ta­tion. Autopsy ­showed extraor­di­nary large, exten­sive soft, brown veg­e­ta­tions in the lower part of the tho­rac­ic aorta above the prop­er­ly infra­ren­al­ly-­placed stent. Microscopic exam­ina­tion ­revealed mul­ti­ple micro­em­bo­li in the liver, ­spleen, pan­cre­as, intes­tines, ­testes, and espe­cial­ly the kid­neys.
Discussion. Early death from micro­em­bo­li after aor­tic stent implan­ta­tion has been report­ed. However, the ­present case devel­oped fatal mul­ti­ple micro­em­bo­li so late that they could not have orig­i­nat­ed from the exclud­ed mural throm­bus. The sud­den death of an oth­er­wise ­healthy man of exten­sive micro­em­bo­li is dif­fi­cult to ­explain. The stent appli­ca­tion may have ­altered the prox­i­mal flow and wall move­ments dis­pos­ing to micro­em­bo­li in the case of veg­e­ta­tions.

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