Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm - Case report

Background. The short term experience of endovascular treatment of abdomina l aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits. Case report. A 70 year-old mildly hypertensive male without previous or pre sent arteriosclerotic, pulmonary, or urological manifestations was subjecte d to endovascular treatment after his mass-screening diagnosed abdominal ao rtic aneurysm had expanded to above 5 cm in diameter, the aneurysm having b een found by CT-scanning and arteriography to be endovascularly treatable. A Vanguard bifurcated aortic stent graft was implanted under epidural/spina l anaesthesia and covered by cephalosporine and heparin (8000 IE) protectio n. Apart from treatment of a groin haematoma and stenosis of the left super ficial femoral artery, the postoperative period presented no problems. A fe w days before the monthly follow-up visit, the patient developed uraemia, g angrene of one foot and dyspnoea. Blood glucose and LDH was elevated, Deter ioration led to death a month and a half after stent implantation. Autopsy showed extraordinary large, extensive soft, brown vegetations in the lower part of the thoracic aorta above the properly infrarenally-placed stent. Mi croscopic examination revealed multiple microemboli in the liver, spleen, p ancreas, intestines, testes, and especially the kidneys. Discussion. Early death from microemboli after aortic stent implantation ha s been reported. However, the present case developed fatal multiple microem boli so late that they could not have originated from the excluded mural th rombus, The sudden death of an otherwise healthy man of extensive microembo li is difficult to explain. The stent application may have altered the prox imal flow and wall movements disposing to microemboli in the case of vegeta tions.