DISSEMINATED INTRAVASCULAR COAGULATION ASSOCIATED WITH ACUTE ISCHEMICHEPATITIS AFTER ELECTIVE AORTIC-ANEURYSM REPAIR - COMPARATIVE-ANALYSIS OF 10 CASES

Objective: To assess the characteristics of patients with perioperativ e disseminated intravascular coagulation (DIG) and acute ischemic hepa titis after elective aortic aneurysm repair (AAR). Design: A retrospec tive case-control study. Setting: A single tertiary referral center. P articipants: Between 1982 and 1993, 1966 patients underwent elective A AR. Of these, 10 patients (eight with abdominal and two with thoracoab dominal aneurysms) developed DIC and acute elevation of serum transami nases consistent with acute ischemic hepatitis during or shortly after surgery. The control group included 30 patients matched by age, sex, year of surgery, and aneurysm type and size. Interventions: None. Meas urements and Main Results: None of the patients in either group had pr eoperative hemostatic abnormalities or other causes for DIG. There was no difference between the two groups in the duration of aortic cross- clamping. In all study patients, severe coagulopathy or systemic hypot ension developed after the aortic cross-clamp was released. This resul ted in significantly increased surgery time after unclamping (p < 0.00 1), and increased estimated blood loss (p < 0.001), DIC developed with in 24 hours, and mean concentrations of aspartate transaminase (4,021 +/- 3.579 IU/L) and lactate dehydrogenase 14,332 +/- 2,903 IU/L) peake d on the second postoperative day. Nine (90%) of the study patients re quired repeat operations (seven for bleeding), and all of them died; t he median survival time was 6 days (mean, 8.3 +/- 8.2 days). Only one patient in the control group needed a repeat operation. Liver infarcti on or necrosis was seen in all seven patients who underwent autopsy or biopsy. Conclusions: The combination of DIC and acute ischemic hepati tis (''hepatohemorrhagic syndrome'') rarely occurs after elective AAR and is associated with a very high mortality rate. DIC was temporally related to the release of the aortic cross-clamp. The cause-effect rel ationship of this rare syndrome cannot be explained by operative cours e before the release of the aortic cross-clamp. Copyright (C) 1997 by W.B. Saunders Company.