CRCM  Vol.4 No.2 , February 2015
Massive Thromboembolism from an Abdominal Aortic Aneurysm after Successful Thrombolysis for an Acute Myocardial Infarction
ABSTRACT
Thrombolytic therapy is indicated to the treatment of patients with ST-elevation myocardial infarction or pulmonary embolism. Its indication should especially consider the risk of bleeding, but other complications might pose harm to patients. Although rarely reported, fibrinolysis can trigger thromboembolic phenomena from emboligenic sources such as aortic aneurysms. Clinicians should be aware of this life-threatening complication. In this case report, we present one patient admitted due to a ST-segment elevation acute myocardial infarction successfully treated with fibrinolytic treatment, but who evolved with a massive microembolism from an abdominal aortic aneurysm. Despite intensive medical care, the patient evolved with multiorganic failure due to distal microembolism to the guts and lower limbs, severe rhabdomyolysis and ultimately to death. In this challenging case, clinical, anatomical and histopathologic features are presented and discussed.

Cite this paper
Bernardi, F. , Rezende, P. , Garzillo, C. , Lima, E. , Luz, D. , Aiello, V. and Hueb, W. (2015) Massive Thromboembolism from an Abdominal Aortic Aneurysm after Successful Thrombolysis for an Acute Myocardial Infarction. Case Reports in Clinical Medicine, 4, 45-49. doi: 10.4236/crcm.2015.42011.
References
[1]   Baxter, B.T., McGee, G.S., Flinn, W.R., et al. (1990) Distal Embolization as a Presenting Symptom of Aortic Aneurysms. American Journal of Surgery, 160, 197-201.
http://dx.doi.org/10.1016/S0002-9610(05)80306-X

[2]   Wingo, J.P., Nix, M.L., Greenfield, L.J., et al. (1986) The Blue Toe Syndrome: Hemodynamics and Therapeutic Correlates of Outcome. Journal of Vascular Surgery, 3, 475-480.
http://dx.doi.org/10.1016/0741-5214(86)90111-4

[3]   Herskowitz, A., Choi, S., Ansari, A.A., et al. (1995) Cytokine mRNA Expression in Postischemic/Reperfused Myocardium. American Journal of Pathology, 146, 419-428.

[4]   Pannitteri, G., Marino, B., Campa, P.P., et al. (1997) Interleukins 6 and 8 as Mediators of Acute Phase Response in Acute Myocardial Infarction. American Journal of Cardiology, 80, 622-625.
http://dx.doi.org/10.1016/S0002-9149(97)00434-7

[5]   Koten, K., Hirohata, S., Miyoshi, T., et al. (2008) Serum Interferon-Gamma-Inducible Protein 10 Level Was Increased in Myocardial Infarction Patients, and Negatively Correlated with Infarct Size. Clinical Biochemistry, 41, 30-37.
http://dx.doi.org/10.1016/j.clinbiochem.2007.10.001

[6]   Tunick, P.A. and Kronzon, I. (2000) Atheromas of the Thoracic Aorta: Clinical and Therapeutic Update. Journal of the American College of Cardiology, 35, 545. http://dx.doi.org/10.1016/S0735-1097(99)00604-X

[7]   Hitti, W.A., Wali, R.K., Weinman, E.J., et al. (2008) Cholesterol Embolization Syndrome Induced by Thrombolytic Therapy. American Journal of Cardiovascular Drugs, 8, 27.
http://dx.doi.org/10.2165/00129784-200808010-00004

[8]   Matchett, W.J., McFarland, D.R., Eidt, J.F., et al. (2000) Blue Toe Syndrome: Treatment with Intra-Arterial Stents and Review of Therapies. Journal of Vascular and Interventional Radiology, 11, 585-592.
http://dx.doi.org/10.1016/S1051-0443(07)61610-8

[9]   Wissgott, C., Kamusella, P. and Andresen, R. (2011) Percutaneous Mechanical Thrombectomy: Advantages and Limitations. Journal of Cardiovascular Surgery, 52, 477-484.

[10]   Chauvapun, J.P. and Dryjski, M. (2005) Distal Peripheral Microembolism. Vascular, 13, 50-57.
http://dx.doi.org/10.1258/rsmvasc.13.1.50

[11]   Blaisdell, F.W., Steele, M. and Allen, R.E. (1978) Management of Acute Lower Extremity Arterial Ischemia Due to Embolism and Thrombosis. Surgery, 84, 822-834.

[12]   Wright, J.G., Kerr, J.C., Valeri, C.R., et al. (1988) Heparin Decreases Ischemia-Reperfusion Injury in Isolated Canine Gracilis Model. Archives of Surgery, 123, 470-472.
http://dx.doi.org/10.1001/archsurg.1988.01400280080014

[13]   Becker, M., Menger, M.D. and Lehr, H.á. (1994) Heparin-Released Superoxide Dismutase Inhibits Postischemic Leukocyte Adhesion to Venular Endothelium. American Journal of Physiology, 267, H925-H930.

[14]   Clowes, A.W., Clowes, M.M., Kirkman, T.R., et al. (1992) Heparin Inhibits the Expression of Tissue-Type Plasminogen Activator by Smooth Muscle Cells in Injured Rat Carotid Artery. Circulation Research, 70, 1128-1136.
http://dx.doi.org/10.1161/01.RES.70.6.1128

 
 
Top