[Dissecting aneurysm of the aorta associated with local consumption coagulopathy].

Abstract

Dissecting aneurysm of the aorta associated with local consumption coagulopathy is a rare clinical entity. We report one such case, a 71-year-old man with DeBakey type I aortic dissection and bleeding tendency. This patient had aortic dissection 4 years previous, and had developed a bleeding tendency in the last 2 years. Both computed tomographic scan and digital subtraction angiographic studies revealed DeBakey type I aortic dissection starting at the ascending aorta and extending all the way down to the renal artery, with an inlet at the aortic arch. The area of false lumen was larger than that of the true lumen, and thrombi were noted within the false lumen. A detailed blood coagulation study of this patient showed thrombocytopenia and coagulopathy. Blood coagulation studies in an additional 13 patients, who were seen at NTUH during the past 1 year with aortic dissection, but without the bleeding tendency, revealed no sign of coagulopathy. From analysis of these patients, we note that a large surface area in a false lumen, thrombus formation within a false lumen and blood flow into a false lumen with stasis seem to be the major determinants for causing coagulopathy in patients with aortic dissection. The treatment of aortic dissection with bleeding tendency caused by local consumption coagulopathy is graft replacement of the aneurysm. Hemostatic abnormalities may cause excessive blood loss during surgical operation, and careful and meticulous management of hemostasis are required.