Operative and nonoperative management of chronic disseminated intravascular coagulation due to persistent aortic endoleak Jeffrey J. Nienaber, MD, Audra.

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Presentation transcript:

Operative and nonoperative management of chronic disseminated intravascular coagulation due to persistent aortic endoleak Jeffrey J. Nienaber, MD, Audra A. Duncan, MD, Gustavo S. Oderich, MD, Rajiv K. Pruthi, MBBS, William L. Nichols, MD Journal of Vascular Surgery Volume 59, Issue 5, Pages 1426-1429 (May 2014) DOI: 10.1016/j.jvs.2013.05.097 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 a, Computed tomography angiography (CTA) demonstrating a large type Ia endoleak. b, CTA demonstrating large infrarenal neck (red arrow, lowest [left] renal artery; yellow line, 36 mm). Journal of Vascular Surgery 2014 59, 1426-1429DOI: (10.1016/j.jvs.2013.05.097) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 a, Three weeks following carotid-carotid-subclavian sequential bypass, a Viabahn chimney graft (W. L. Gore & Associates Inc) was positioned in the innominate artery via right brachial access, and a Medtronic Talent device (Medtronic Inc) was used to extend the prior thoracic endovascular aneurysm repair (TEVAR) to the proximal aortic arch. The proximal left subclavian artery was subsequently occluded with an Amplatzer Vascular Plug (St. Jude Medical, St. Paul, Minn). b, Subsequent computed tomography angiography (CTA) illustrates the completed hybrid debranching repair. c, Initial treatment of the recurrent endoleak with coil embolization and Onyx (ev3 Inc). d, Rerecurrence of the endoleak prompted a second treatment with coil embolization and Onyx, with subsequent resolution of the endoleak and sac shrinkage. Journal of Vascular Surgery 2014 59, 1426-1429DOI: (10.1016/j.jvs.2013.05.097) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 Platelet count, fibrinogen, and D-dimer levels in response to surgery (OR) and transfusion of cryoglobulin (C, 20 units) or platelets (P, 2 units, pooled). Journal of Vascular Surgery 2014 59, 1426-1429DOI: (10.1016/j.jvs.2013.05.097) Copyright © 2014 Society for Vascular Surgery Terms and Conditions