Patel Ashish S, Bell Rachel, Hunt Beverley J, Taylor Peter R
Department of Vascular Surgery, Guy's & St. Thomas' Hospital, London, United Kingdom.
J Vasc Surg. 2009 Apr;49(4):1046-9. doi: 10.1016/j.jvs.2008.11.055.
Disseminated intravascular coagulation (DIC) has been shown to affect 2% to 4% of patients with abdominal aortic aneurysms. In rare cases of DIC caused by aneurysms, operative repair has been curative. Endovascular aneurysm repair (EVAR) has been established as an effective treatment. We report a 73-year-old man in whom severe bleeding developed from groin incisions and cannulae sites immediately after EVAR. An intraoperative angiogram showed a type I endoleak, but the procedure had to be abandoned due to continued bleeding. Blood tests confirmed a diagnosis of disseminated intravascular coagulation that persisted chronically 3 months postoperatively. Attempts to repair the endoleak with stenting were unsuccessful, resulting in persistence of disseminated intravascular coagulation. This resolved after successful treatment of the endoleak with aortic banding.
已证实,弥散性血管内凝血(DIC)影响2%至4%的腹主动脉瘤患者。在罕见的由动脉瘤引起的DIC病例中,手术修复具有治愈效果。血管内动脉瘤修复术(EVAR)已被确立为一种有效的治疗方法。我们报告了一名73岁男性,在接受EVAR后,腹股沟切口和插管部位立即出现严重出血。术中血管造影显示为I型内漏,但由于持续出血,手术不得不放弃。血液检查确诊为弥散性血管内凝血,术后3个月仍长期存在。尝试用支架修复内漏未成功,导致弥散性血管内凝血持续存在。在通过主动脉束带成功治疗内漏后,这种情况得到了解决。