A Case of Intraoperative Embolic Events during EVAR Causing Multiple Sequential Complications of Lower Limb Ischemia, Small Intestinal Perforation, and Iliopsoas Hematoma

Abstract

A 85-year-old female with a 77-mm abdominal aortic aneurysm underwent endovascular aneurysm repair. She developed ischemic complications due to intraoperative microembolism, including pale left toe observed immediately after surgery, lumbar subcutaneous bleeding recognized on postoperative day (POD) 1, small intestinal perforation occurred on POD 12, and iliopsoas hematoma secondary to ischemia-reperfusion injury developed on POD 36 and 44. Symptoms of intraoperative microembolism vary widely those depend on affected arteries and severity of ischemia. In addition, ischemia-reperfusion injury can result in a variety of outcomes, including iliopsoas hematoma. In case with severe atherosclerosis, careful postoperative management is required.