A suspected case of acquired factor V deficiency after thoracic endovascular aortic repair for left bronchial puncture of anastomotic pseudoaneurysm

Abstract

Acquired factor V deficiency (AFVD) is a rare disease with an incidence of 1 in 1,000,000 and only about 200 cases reported in the literature. AFVD develops in response to the appearance of factor V inhibitor and is associated with a variety of factors, including treatment with bovine thrombin or antibacterial agents, surgery, cancer, infection, autoimmune disease, and blood transfusion, and may be idiopathic. Our case was a man in his 80’s who had a history of arch aortic replacement and was being treated for asymptomatic subacute infective endocarditis. Postoperatively, he developed hemoptysis with extravasation into the left bronchus from a pseudoaneurysm at the site of anastomosis of the prosthetic graft. A thoracic endovascular aortic repair was performed, and his postoperative course was good. However, his prothrombin and activated partial thromboplastin times were found to be prolonged. A cross-mixing test raised suspicion for AFVD, which meant that the patient had been at high risk of perioperative bleeding. Fortunately, his condition improved spontaneously after thoracic endovascular aortic repair. It is important to identify AFVD if there is abnormal coagulation or prolongation of prothrombin and activated partial thromboplastin times because of the risk of fatal bleeding.