Total arch replacement for the enhanced-fibrinolytic-type disseminated intravascular coagulation patient with endoleak after thoracic endovascular aortic repair for aortic dissection

Abstract

BackgroundEndoleaks after stent graft treatment can cause disseminated intravascular coagulation (DIC), leading to a bleeding tendency.Case presentationA 69-year-old man received thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection. After that, he developed bleeding tendency, and the diameter of his distal aortic arch increased. We diagnosed him with enhanced fibrinolytic-type DIC associated with a type Ia endoleak. We decided to perform a total arch replacement for the endoleak closure. To reduce the risk of massive bleeding, transfusion of fresh frozen plasma and platelets, oral tranexamic acid, and intravenous recombinant human soluble thrombomodulin were administered in the perioperative period. According to the multidisciplinary approach, the DIC improved, and the patient recovered.ConclusionWe successfully treated an endoleak-related DIC patient with bleeding tendency and combined correction for coagulopathy with supportive treatments.