Abstract
Thrombolytic therapy is indicated to the treatment of patients with ST-elevation myocardial infarction or pulmonary embolism. Its indication should especially consider the risk of bleeding, but other complications might pose harm to patients. Although rarely reported, fibrinolysis can trigger thromboembolic phenomena from emboligenic sources such as aortic aneurysms. Clinicians should be aware of this life-threatening complication. In this case report, we present one patient admitted due to a ST-segment elevation acute myocardial infarction successfully treated with fibrinolytic treatment, but who evolved with a massive microembolism from an abdominal aortic aneurysm. Despite intensive medical care, the patient evolved with multiorganic failure due to distal microembolism to the guts and lower limbs, severe rhabdomyolysis and ultimately to death. In this challenging case, clinical, anatomical and histopathologic features are presented and discussed.
Highlights
Thromboembolic phenomenon from aortic aneurysms in the setting of thrombolytic therapy for acute occlusive vascular syndromes is a rare but severe event
Clinicians should be aware that vascular aneurysms, like aortic aneurysms, are potential sites of embolic showers and should be thought and carefully considered in patients with vascular diseases especially before fibrinolytic treatment is accomplished
We present a catastrophic thromboembolic event from an abdominal aortic aneurysm (AAA) triggered by thrombolytic therapy in a patient with acute ST-elevation myocardial infarction (STEMI)
Summary
Thromboembolic phenomenon from aortic aneurysms in the setting of thrombolytic therapy for acute occlusive vascular syndromes is a rare but severe event. Clinicians should be aware that vascular aneurysms, like aortic aneurysms, are potential sites of embolic showers and should be thought and carefully considered in patients with vascular diseases especially before fibrinolytic treatment is accomplished. In such cases, the identification of the source of the embolization and the definition of the characteristics of the emboli are central to the best treatment option that should be applied in order to add survival chances in this life-threatening complication
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