Deep vein thrombosis and pulmonary embolism in a patient with acute type B aortic dissection: a case report

Yıl 2019, Cilt: 5 Sayı: 1, 202 - 205, 04.01.2019

Engin Akgül , Gülen Sezer Alptekin Erkul Sinan Erkul Ahmet Hakan Vural

https://doi.org/10.18621/eurj.403641

Cited By: 1

Öz

Acute
dissection involving ascending aorta contains high risk of mortality and requires
surgical treatment immediately. Venous thrombosis can manifested as deep vein
thrombosis or pulmonary embolism. It may be isolated or complication of another
disease. Because of pulmonary thromboembolism risk, treatment of deep vein
thrombosis is strongly recommended. A 61-year-old male patient with severe back
pain and shortness of breath presented to the emergency service. The findings
of the physical examinations, chest x-ray and electrocardiogram were normal. Contrast-enhanced
computerized tomography showed an aortic intimal tear that started just below
the subclavian artery and extended into the iliac arteries. The patient was hospitalized
and the medical treatment started. On the 4^th day of clinical
follow-up, pain and swelling started at his right leg with severe shortness of
breath. Venous Doppler ultrasound was performed and there were thrombosis at
popliteal, femoral and even at iliac veins. Computed tomography showed pulmonary
embolism at pulmonary trunk. Aortic dissection treated with endovascular stent
graft firstly to prevent aortic rupture because of anticoagulation and then
pulmonary embolism treated with anticoagulant drugs. Hypercoagulation is a self
defence of the body for limiting the aortic intimal tear to prevent aortic
rupture. So many complications could be seen because of this situation and the
physicians should be awaken for this. 

Anahtar Kelimeler

acute aortic dissection, deep vein thrombosis, pulmonary embolism, endovascular stent graft, anticoagulation

Kaynakça

• [1] Pape L, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, diagnosis and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol 2015;66:350-8.
• [2] Yavuz S. Alternative cannulation techniques in surgical repair for acute type A aortic dissection. Eur Res J 2016;2:1-6.
• [3] Nienaber CA, Kische S, Rousseau H, Eggebrecht H, Rehders TC, Kundt G, et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv 2013;6:407-16.
• [4] Grimm JC, Magruder JT, Crawford TC, Sciortino CM, Zehr KJ, Mandal K, et al. Differential outcomes of type A dissection with malperfusion according to affected organ system. Ann Cardiothorac Surg 2016;5:202-8.
• [5] Tapson VF. Acute pulmonary embolism. N Engl J Med 2008;358:1037-52.
• [6] Yavuz S, Toktas F, Goncu T, Eris C, Gucu A, Ay D, et al. Surgical embolectomy for acute massive pulmonary embolism. Int J Clin Exp Med 2014;7:5362-75.
• [7] Appoo JJ, Bozinovski J, Chu MW, El-Hamamsy I, Forbes TL, Moon M, et al. Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular Surgery for Thoracic Aortic Disease. Can J Cardiol 2016;32:703-13.
• [8] Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol 2013;61:1661-78.
• [9] Sher A, Tadros RO. Is there a role for expanding the indication for TEVAR in acute type B aortic dissections? A further classification of uncomplicated dissections. J Vasc Endovasc Surg 2016;1:3.
• [10] Kagawa Y, Ota S, Hoshino K, Yamada N, Nakamura M, Ito M. Acute pulmonary thromboembolism and deep vein thrombosis during the medical treatment of acute aortic dissection was successfully treated by the combination of inferior vena cava filter installation and anti-coagulant therapy: a case report. Ann Vasc Dis 2015;8:36-9.
• [11] Jo Y, Anzai T, Ueno K, Kaneko H, Kohno T, Sugano Y et al. Re-elevation of D-dimer as a predictor of re-dissection and venous thromboembolism after Stanford type B acute aortic dissection. Heart Vessels 2010;25:509-14.