P08 | A rare case of DIC: when hematology meets vascular surgery

C. Angoli, O. Para, I. Liguori, C. La Rovere, A. De Roma, M. Al Refaie, M. Onesto, L. Barbacci, S. Romano, C. Nozzoli | AOU Careggi, Firenze, Italy

Background: Distal stent graft induced new entry is a rare complication of chronic aortic dissection after intervention of endovascular aortic repair.
Description of the case report: A 75 years old man entered our hospital for lombar pain, loss of genital sensitivity and inferior limbs hypostenia. He had history of hypertension, atrial fibrillation treated with anticoagulant, unexplained anemia and thrombocytopenia and two prosthetic replacements of aortic arch because of an aneurysmal dilatation occurred about ten years ago. A spinal column RM excluded cauda syndrome and, in according to EMG, diagnosed a chronic polyradiculopathy because of multiple disc herniations without neurosurgical indications; as a collateral finding, this RM found a thoracic and lombar aortic dilatation. An angioTc confirmed these findings and found an intimal flap nearby the thoracic endoprotesis. Neither cardiac nor vascular surgical indications were placed. Concurrently at the blood exams anemia and thrombocytopenia were confirmed: thrombotic thrombocytopenic purpura, virological and autoimmune causes, folate, iron and vitamin B12 deficiency were excluded. A bone marrow biopsy was performed. An elevated d-dimer was found and an angioTc excluded a pulmonary thromboembolism. The entire case was interpreted as a chronic platelet aggregation and activation of coagulation cascade in the thoracic pseudoaneurysm as a consequence of the endothelial damage provoked by the prothesis.
Conclusions: This endoprotesis damage can lead to the activation and consumption of platelets and coagulation factors.