Pulmonary embolism following endovascular aortic repair for a ruptured abdominal aortic aneurysm: A case report

Introduction and importance: The primary complications of ruptured abdominal aortic aneurysms (AAAs) include abdominal compartment syndrome, ischemic enteritis, cardiac complications, and lower limb ischemia. Pulmonary embolisms (PEs) resulting from deep venous thrombosis (DVT) are uncommon. Herein, we report an important case in which a critical PE developed in a patient after emergency endovascular aortic repair (EVAR) for a ruptured AAA. Notably, the patient's life was saved through cardiac surgery without compromising his activities of daily living. Presentation of case: A 64-year-old man was admitted to our hospital with a ruptured AAA and a massive right retroperitoneal hematoma. We performed emergency EVAR, and an open abdomen and temporary abdominal closure technique. On post-operative day 5, he experienced sudden cardiac arrest due to PE caused by DVT. An emergency pulmonary artery thrombectomy was performed. The abdomen was opened again and the retroperitoneal hematoma was removed. The postoperative course was uneventful and the patient was discharged without sequelae. Clinical discussion: The thrombus formation was considered to have been caused by an aneurysm and a retroperitoneal hematoma that compressed the inferior vena cava. Conclusion: If a ruptured AAA protrudes toward the right side and is associated with a large right-sided hematoma, clinicians might have to consider removing the hematoma simultaneously via EVAR.