A Case of Debranching TEVAR for a Descending Thoracic Aortic Aneurysm with Localized Dissection Complicated by Disseminated Intravascular Coagulation

Abstract

We reported a debranching TEVAR for a descending thoracic aortic aneurysm with localized dissection complicated by disseminated intravascular coagulation (DIC). A 76-year-old man was admitted to our hospital due to acute kidney dysfunction, anemia and thrombocytopenia. A computed tomographic scan revealed a descending thoracic aortic aneurysm with localized dissection. The maximum aneurysm diameter was 51 mm. He was also diagnosed as DIC due to the aneurysm with dissection. Because he was too frail to undergo open repair of the aneurysm, we decided to perform a debranching TEVAR. Recombinant thrombomodulin was administered preoperatively to alleviate DIC. An axillary-axillary-carotid bypass with a T-shaped GoreTex graft^® was followed by endografting with TX2 thoracic stent grafts (34 mm, 38 mm). The disseminated intravascular coagulation was improved after surgery. Postoperative enhanced computed tomography showed shrinkage of the aneurysm sac with no endoleak. We believe that debranching TEVAR is one of the useful strategies for a descending thoracic aortic aneurysm with DIC.