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

## TL;DR

A patient with a ruptured abdominal aortic aneurysm developed a life-threatening pulmonary embolism after surgery, highlighting the need for careful monitoring and management of venous compression.

## Contribution

This case report highlights the rare but critical risk of pulmonary embolism following endovascular aortic repair for ruptured aneurysms with retroperitoneal hematoma.

## Key findings

- Retroperitoneal hematoma from a ruptured AAA can compress veins, leading to deep venous thrombosis and pulmonary embolism.
- Emergency pulmonary artery thrombectomy and hematoma removal saved the patient's life.
- Careful monitoring of fibrinolytic markers is recommended in such cases to prevent complications.

## Abstract

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.

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.

The thrombus formation was considered to have been caused by an aneurysm and a retroperitoneal hematoma that compressed the inferior vena cava.

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.

•Ruptured abdominal aortic aneurysms with extensive retroperitoneal hematoma, particularly when the aneurysm extends to the right side, may compress the inferior vena cava and iliac vein.•Large venous thrombosis caused by compression may lead to a life-threatening pulmonary embolism.•Retroperitoneal incision and hematoma removal should be considered when selecting endovascular aortic repair for ruptured abdominal aortic aneurysms.•Careful monitoring of fibrinolytic markers is necessary and early examination is required for patients with high values, even in those who are asymptomatic.

Ruptured abdominal aortic aneurysms with extensive retroperitoneal hematoma, particularly when the aneurysm extends to the right side, may compress the inferior vena cava and iliac vein.

Large venous thrombosis caused by compression may lead to a life-threatening pulmonary embolism.

Retroperitoneal incision and hematoma removal should be considered when selecting endovascular aortic repair for ruptured abdominal aortic aneurysms.

Careful monitoring of fibrinolytic markers is necessary and early examination is required for patients with high values, even in those who are asymptomatic.