Perioperative disseminated intravascular coagulation following the surgery of abdominal aorta aneurysmal disease

Abstract

Disseminated intravascular coagulation (DIC) represents a pathological activation of coagulation (blood clotting) mechanisms that happens in response to a variety of diseases. Diseases of the blood vessels, such as aorta aneurysmal disease, could also cause local activation of coagulation. We report a case of DIC in a patient after the surgery of abdominal aorta aneurysm. 64-year-old woman was admitted to the Clinic for vascular surgery for the diagnosis and surgical treatment of abdominal aorta aneurysm. Multidetector computed tomography (MDCT) angiography verified abdominal aorta aneurysm 5.2 cm in diameter with significant aortoiliac stenosis and thereby aneurysm resection with aortobifemoral reconstruction was indicated. The operation went uneventfully but after completed reconstruction and declamping thrombosis of both limbs of Y graft was verified. Immediate bilateral thrombectomy was performed with the blood being sent for detailed analysis that revealed the presence of DIC. Regular monitoring of hemostatic parameters (coagulation factors, platelet function and rotational thromboelastometry (ROTEM)) enabled timely substitution and administration of anticoagulant therapy during and after surgery. On the 9th postoperative day the patient was discharged in good general condition. Forty days after surgery, the patient feels good with lower limbs vascularization well preserved. Early recognition of disseminated intravascular coagulation during the surgery by attending vascular surgeon, in cooperation with transfusiology center, is of great importance for well-timed detection and treatment of DIC and preventing serious and potentially lethal hemorrhagic and thrombotic complications in these patients.