Management of acute pulmonary embolism after acute aortic dissection surgery

Abstract

Acute aortic dissection (AAD) continues to be associated with high mortality and morbidity. Pulmonary embolism is also a life-threatening disease. The treatment of these life-threatening diseases remains controversial in case complications arise. Thrombolytic therapy and intensive treatment would be needed to manage these fatal diseases. A 49-year-old man with progressive back pain was admitted to our hospital. Computed tomography (CT) scan revealed type A AAD. Emergency operation for hemiarch replacement was performed. Two weeks postoperatively, the patient's oxygenation worsened and his d-dimer levels elevated. CT scan revealed a massive thrombus in the bilateral pulmonary arteries. Intensive anticoagulation therapy was started immediately. On postoperative day 27, the patient was weaned from mechanical ventilation, but the false lumen with thrombus was recanalized again. The patient was discharged on postoperative day 75 without resulting in major complications for aortic dissection. The diagnosis of pulmonary embolism concomitant with AAD is difficult. The treatment of pulmonary embolism after AAD is controversial. Our strategy seems to be suitable for acute pulmonary embolism that occurs during the treatment of AAD. ˂Learning objective: The diagnosis of pulmonary embolism concomitant with acute aortic dissection (AAD) is difficult. The treatment of pulmonary embolism after AAD is controversial. Investigating factor XIII levels might help in the early detection of pulmonary embolism.>.

Keywords: Anticoagulation therapy; Aortic dissection; Pulmonary embolism; Thrombus.

Fig. 1

Type A acute aortic dissection with a patent false lumen.

Fig. 2

Graph showing fluctuations in d-dimer level and other factors. On the 14th postoperative day, the patient’s d-dimer levels increased again to 94 μg/mL. Anticoagulation therapy is presented toward the top of the graph. FDP, fibrin degradation products; PE, pulmonary embolism; POD, postoperative day.

Fig. 3

(a) Massive thrombus filling the bilateral pulmonary artery. (b) Disappearance of the major thrombus in the pulmonary artery. The descending aorta was changed to a patent false lumen type again.