Deep vein thrombosis and pulmonary embolism in a patient with acute type B aortic dissection: a case report

Acute dissection involving ascending aorta contains high risk of mortality and requires surgical treatmentimmediately. Venous thrombosis can manifested as deep vein thrombosis or pulmonary embolism. It may beisolated or complication of another disease. Because of pulmonary thromboembolism risk, treatment of deepvein thrombosis is strongly recommended. A 61-year-old male patient with severe back pain and shortness ofbreath presented to the emergency service. The findings of the physical examinations, chest x-ray andelectrocardiogram were normal. Contrast-enhanced computerized tomography showed an aortic intimal tearthat started just below the subclavian artery and extended into the iliac arteries. The patient was hospitalizedand the medical treatment started. On the 4th day of clinical follow-up, pain and swelling started at his right legwith severe shortness of breath. Venous Doppler ultrasound was performed and there were thrombosis atpopliteal, femoral and even at iliac veins. Computed tomography showed pulmonary embolism at pulmonarytrunk. Aortic dissection treated with endovascular stent graft firstly to prevent aortic rupture because ofanticoagulation and then pulmonary embolism treated with anticoagulant drugs. Hypercoagulation is a selfdefence of the body for limiting the aortic intimal tear to prevent aortic rupture. So many complications couldbe seen because of this situation and the physicians should be awaken for this.

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[1] Pape L, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, diagnosis and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol 2015;66:350-8.
[2] Yavuz S. Alternative cannulation techniques in surgical repair for acute type A aortic dissection. Eur Res J 2016;2:1-6.
[3] Nienaber CA, Kische S, Rousseau H, Eggebrecht H, Rehders TC, Kundt G, et al. Endovascular repair of type B aortic dissection: longterm results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv 2013;6:407-16.
[4] Grimm JC, Magruder JT, Crawford TC, Sciortino CM, Zehr KJ, Mandal K, et al. Differential outcomes of type A dissection with malperfusion according to affected organ system. Ann Cardiothorac Surg 2016;5:202-8.
[5] Tapson VF. Acute pulmonary embolism. N Engl J Med 2008;358:1037-52.
[6] Yavuz S, Toktas F, Goncu T, Eris C, Gucu A, Ay D, et al. Surgical embolectomy for acute massive pulmonary embolism. Int J Clin Exp Med 2014;7:5362-75.
[7] Appoo JJ, Bozinovski J, Chu MW, El-Hamamsy I, Forbes TL, Moon M, et al. Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular Surgery for Thoracic Aortic Disease. Can J Cardiol 2016;32:703-13.
[8] Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol 2013;61:1661-78.
[9] Sher A, Tadros RO. Is there a role for expanding the indication for TEVAR in acute type B aortic dissections? A further classification of uncomplicated dissections. J Vasc Endovasc Surg 2016;1:3.
[10] Kagawa Y, Ota S, Hoshino K, Yamada N, Nakamura M, Ito M. Acute pulmonary thromboembolism and deep vein thrombosis during the medical treatment of acute aortic dissection was successfully treated by the combination of inferior vena cava filter installation and anticoagulant therapy: a case report. Ann Vasc Dis 2015;8:36-9.
[11] Jo Y, Anzai T, Ueno K, Kaneko H, Kohno T, Sugano Y et al. Reelevation of D-dimer as a predictor of re-dissection and venous thromboembolism after Stanford type B acute aortic dissection. Heart Vessels 2010;25:509-14.