Disseminated intravascular coagulation in a patient after endovascular aneurysm repair due to symptomatic abdominal aortic and iliac artery aneurysm

Dear Editor,
Here, we present a case of rapidly progressing disseminated intravascular coagulation (DIC) following bifurcated stent graft implantation in a patient with symptomatic large abdominal aortic and iliac artery aneurysm.
A 71-year-old patient was admitted to the vascular surgery department during duty hours with a symptomatic aneurysm of the abdominal aorta and iliac arteries, 77 mm in dia­meter, diagnosed in computed tomography. The patient was suffering from ischae­mic heart disease (condition after myocardial infarction with ST-segment elevation two months prior to admission), chronic kidney disease, generalized atherosclerosis, and hyperlipidaemia. On admission, the general condition of the patient was fairly good, with circulatory and respiratory efficiency, and moderate pain in the abdominal cavity. Due to the high arterial pressure, an intravenous infusion of vasodilators was used, which resulted in pain relief.
Due to the inability to discontinue antiplatelet therapy, the patient was urgently qualified for EVAR (endovascular aneurysm repair). The patient was classified as class IV according to the American Society of Anaesthesiologists (ASA) Physical Status Classification System and qualified for local anaesthesia. During the procedure, vital parameters were monitored (blood pressure measured by indirect method, SaO2, ECG). The urinary bladder was catheterized and diuresis was monitored hourly. Passive oxygen therapy through a mask was applied. Before the start of the procedure, 1 γ of paracetamol intravenously (as part of advance analgesia) and cefazolin (according to the principles of local prevention of infections in the hospital) were administered. Inguinal puncture sites were anesthetized with a solution containing a mixture of 2% lidocaine and 0.5% bupivacaine, not exceeding the maximum dose. All punctures were ultrasound-guided. Difficult aneurysm configuration was associated with extended duration of the procedure. In the first stage of the procedure, a bifurcated main body stent graft and a hidden stent into the left renal artery were implanted. In the next stages, graft limbs were embedded. The final angiography confirmed the integrity of the stent graft and no evidence of extravasation or leakage. The operator’s attention was drawn to the lack of flow in the left renal artery and a significant reduction in flow in the vessels of the right kidney. On this basis, it was concluded that intravascular...


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