title: Fatal diffuse atheromatous embolization following endovascular grafting for an abdominal aortic aneurysm: report of a case.
abstract: A 78-year-old woman with an abdominal aortic aneurysm, 57 mm in diameter, was admitted to our hospital for endovascular grafting. Preoperative computed tomography and angiography showed friable mural thrombus in the suprarenal and infrarenal aorta, and a diagnosis of shaggy aorta was made. Postoperatively, the patient suffered cerebral infarction, and disseminated intravascular coagulopathy with multiple organ failure developed, resulting in early death on the third day after surgery. An autopsy revealed diffuse atheromatous embolization into the celiac, superior mesenteric, bilateral renal, bilateral hypogastric (trash buttock), and peripheral arteries. This case report serves to demonstrate that an abdominal aortic aneurysm with a shaggy aorta in the proximal neck is a contraindication to endovascular grafting, and that predicting the possibility of diffuse atheromatous embolization by detecting a shaggy aorta is the best way to prevent this catastrophic complication.
authors.affiliation: First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Zempo
authors.forename: H
authors.initials: H
authors.lastname: Sakano
authors.forename: S
authors.initials: S
authors.lastname: Ikenaga
authors.forename: M
authors.initials: M
authors.lastname: Harada
authors.forename: A
authors.initials: A
authors.lastname: Yamashita
authors.forename: N
authors.initials: N
authors.lastname: Morikage
authors.forename: M
authors.initials: M
authors.lastname: Harada
authors.forename: H
authors.initials: H
authors.lastname: Takenaka
authors.forename: K
authors.initials: K
authors.lastname: Fujioka
authors.forename: K
authors.initials: K
authors.lastname: Esato
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D001012:Aorta, Abdominal / Q000473:pathology; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging* / Q000473:pathology; D019917:Blood Vessel Prosthesis Implantation; D004617:Embolism / Q000000981:diagnostic imaging* / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D015607:Stents; D014057:Tomography, X-Ray Computed