Abstract
We report a patient who developed disseminated intravascular coagulation (DIC) following a type 1a endoleak after an endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm (AAA), and who improved after open surgery. An 82-year-old woman underwent EVAR for a 50-mm infrarenal AAA in July 2012. Argatroban was used as anticoagulant because she had a history of heparin-induced thrombocytopenia. Postoperatively, a type 4 endoleak was present. Three months after the EVAR, she was admitted due to severe anemia and DIC. Computed tomography showed an endoleak with no evidence of an increase in size of AAA and huge intramuscular hematoma in her right thigh. The DIC was treated medically, but when the thrombomodulin was stopped, the thrombopenia progressed. Since no other cause of the DIC was found, we diagnosed that a consumption coagulopathy in the aneurysm sac was occured. She was re-treated to stop the leak completely. Angiography showed a type 1a endoleak. The volume of the endoleak was minimized but not disappeared following placement of a cuff and extra-large stent in the proximal neck, and then we proceeded with open psurgery to eliminate the leak completely. Postoperatively, the DIC improved and has not returned.
