A rare case of fatal multi-organ polymer graft material and cholesterol embolization following aortic repair

Cardiovasc Pathol. 2021 Jan-Feb:50:107287. doi: 10.1016/j.carpath.2020.107287. Epub 2020 Sep 13.

Abstract

Ischemia is a common complication of various endovascular procedures including endovascular aortic aneurysm repair. Multiple mechanisms can contribute to the pathogenesis of ischemia: thrombosis, arterial dissection, graft malpositioning, cholesterol embolization, and polymer graft embolization which is an underrecognized complication. To the best of our knowledge, only 38 cases of polymer graft embolization have been reported in the literature. The phenomenon has been reported in different organs including brain, heart, lungs, kidneys, bowel, liver, and skin. We report a unique case of fatal simultaneous cholesterol and polymer graft embolization with subsequent ischemic infarction of multiple organs (liver, kidneys, spleen, pancreas, duodenum, and stomach) in a 76-year-old woman following endovascular repair for an enlarging thoracic aortic aneurysm.

Keywords: EVAR; Polymer; aneurysm; cholesterol; embolism; graft.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aortic Aneurysm, Thoracic / diagnostic imaging
  • Aortic Aneurysm, Thoracic / surgery*
  • Autopsy
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / instrumentation*
  • Blood Vessel Prosthesis*
  • Embolism, Cholesterol / diagnosis
  • Embolism, Cholesterol / etiology*
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation*
  • Fatal Outcome
  • Female
  • Foreign-Body Migration / diagnosis
  • Foreign-Body Migration / etiology*
  • Humans
  • Infarction / diagnosis
  • Infarction / etiology*
  • Multiple Organ Failure / diagnosis
  • Multiple Organ Failure / etiology*
  • Treatment Outcome