title: Retroperitoneal aortic hemorrhage caused by penetration of an endovascular stent-graft anchoring barb.
abstract: OBJECTIVE
  To report a rare case of acute intraoperative retroperitoneal hemorrhage secondary to aortic penetration by the suprarenal anchoring barb on a stent-graft.
  
  
  METHODS
  A 75-year-old patient on dual antiplatelet therapy for coronary stents and low-molecular-weight heparin for atrial thrombus underwent elective endovascular repair of a 6.7-cm infrarenal abdominal aortic aneurysm. A device with suprarenal fixation and metal anchoring barbs was implanted, and a molding balloon was used that at no time covered the proximal bare metal stents or barbs. In recovery, the patient became tachycardic and hypotensive. After resuscitation, imaging identified an anterior barb penetrating the aortic wall, causing the acute retroperitoneal hemorrhage. A decision to treat conservatively rather than resort to open surgery was difficult but ultimately influenced by the patients' high risk for open surgery. The patient was treated by aggressive reversal of heparin and platelet transfusion, and the bleed settled spontaneously.
  
  
  CONCLUSIONS
  Major surgery and subsequent morbidity may be avoided by medical management of what would appear to be a surgical problem.
authors.affiliation: Department of Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. chris_twine@hotmail.com
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Twine
authors.forename: Andrew
authors.initials: A
authors.lastname: Winterbottom
authors.forename: Nadeem
authors.initials: N
authors.lastname: Shaida
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Boyle
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000293:injuries*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D012187:Retroperitoneal Space; D015607:Stents / Q000009:adverse effects*