Fatal Diffuse Atheromatous Embolization Following Endovascular Grafting for an Abdominal Aortic Aneurysm : Report of a Case

• Published in: Surgery today (Tokyo, Japan) Vol. 31; no. 3; pp. 269 - 273
• Main Authors: Zempo, Nobuya, Sakano, Hisashi, Ikenaga, Shigeru, Harada, Masakazu, Yamashita, Akimasa, Morikage, Noriyasu, Harada, Mikihiko, Takenaka, Hiroaki, Fujioka, Kentaro, Esato, Kensuke
• Format: Journal Article
• Language: English
• Published: Japan 01.01.2001
• Subjects: Aged; Angiography, Digital Subtraction; Aorta, Abdominal - pathology; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - pathology; Aortic Aneurysm, Abdominal - surgery; Arteriosclerosis - diagnostic imaging; Arteriosclerosis - pathology; Blood Vessel Prosthesis Implantation; Diffuse atheromatous embolization; Disseminated intravascular coagulopathy; Embolism - diagnostic imaging; Embolism - pathology; Endovascular grafting; Fatal Outcome; Female; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - pathology; Humans; Shaggy aorta; Stents; Tomography, X-Ray Computed; Trash buttock
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s005950170185

A 78-year-old woman with an abdominal aortic aneurysm, 57 mm in diameter, was admitted to our hospital for endovascular grafting. Preoperative computed tomography and angiography showed friable mural thrombus in the suprarenal and infrarenal aorta, and a diagnosis of shaggy aorta was made. Postoperatively, the patient suffered cerebral infarction, and disseminated intravascular coagulopathy with multiple organ failure developed, resulting in early death on the third day after surgery. An autopsy revealed diffuse atheromatous embolization into the celiac, superior mesenteric, bilateral renal, bilateral hypogastric (trash buttock), and peripheral arteries. This case report serves to demonstrate that an abdominal aortic aneurysm with a shaggy aorta in the proximal neck is a contraindication to endovascular grafting, and that predicting the possibility of diffuse atheromatous embolization by detecting a shaggy aorta is the best way to prevent this catastrophic complication.