Fatal diffuse atheromatous embolization following endovascular grafting for an abdominal aortic aneurysm: Report of a case

A 78-year-old woman with an abdominal aortic aneurysm, 57 mm in diameter, w as admitted to our hospital for endovascular grafting. Preoperative compute d tomography and angiography showed friable mural thrombus in the suprarena l and infrarenal aorta, and a diagnosis of shaggy aorta was made. Postopera tively, the patient suffered cerebral infarction, and disseminated intravas cular coagulopathy with multiple organ failure developed, resulting in earl y death on the third day after surgery. An autopsy revealed diffuse atherom atous embolization into the celiac, superior mesenteric, bilateral renal, b ilateral hypogastric (trash buttock), and peripheral arteries. This case re port serves to demonstrate that an abdominal aortic aneurysm with a shaggy aorta in the proximal neck is a contraindication to endovascular grafting, and that predicting the possibility of diffuse atheromatous embolization by detecting a shaggy aorta is the best way to prevent this catastrophic comp lication.