Iatrogenic Aortic Dissection — a Rare but Lethal Complication of Cardiac Catheterization. Series Case Report

1Good Samaritan Hospital, Cincinnati, OH
2Good Samaritan Hospital, Cincinnati, OH
3Good Samaritan Hospital, Cincinnati, OH

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 500

Case Presentation:

We present 2 case reports, within a 1‐year period, of patients with no underlying aortic dissection, presenting with complaints mandating cardiac catheterization that culminated into aortic dissection. A 48‐year‐old man with a history of schizoaffective disorder and polysubstance abuse presented to the hospital after suicide attempt with multiple drugs overdose. He was found to have bilateral aspiration pneumonia and was intubated. He had a coronary angiogram just a day ago in another facility that showed normal coronaries with no signs of dissection. After initial management in the ER, he was admitted to the ICU and had Chest CT angiogram to rule out pulmonary embolism. CTA showed aortic dissection involving innominate artery dissecting all the way down to the aortic valve. As the patient had a coronary angiogram just a day ago with no dissection, we believe that the angiogram played a role in development of aortic dissection. The other patient was a 42‐year‐old woman with a history of hypertension and CAD who presented with symptoms and findings consistent with acute pancreatitis. The diagnosis was made on the basis of H&P as well as a CT scan of chest and abdomen with no evidence of aneurysm or dissection. Later that day, she developed pulmonary edema and had ST segment elevation on EKG with elevation of cardiac enzymes (troponins 38 μg/L). An emergency cardiac catheterization with angioplasty was done, but she continued to deteriorate and CXR showed widening of mediastinum. Repeat CT scan of chest and abdomen revealed type A dissection from the arch of aorta to common iliac arteries. After heroic attempts at surgery, dissection was repaired. She survived the surgery; however, she sustained anoxic brain injury. Within 24 hours, she deteriorated with CT scan head showing diffuse cerebral edema. She was maintained on life support until family decided to withdraw care. Considering no evidence of aneurysm or dissection in the CT scan prior to catheterization, we believe that, catheterization was vital in the development of aortic dissection

Discussion:

IAD is a potentially lethal illness that can present in an occult manner making the initial diagnosis difficult. Aggressive management along with urgent diagnosis and surgery is mandatory. Incidence is reported to be 0.04% being significantly higher in interventional (0.12%) rather than diagnostic procedures (0.01%). Aortocoronary dissection is usually managed with immediate coronary artery stenting of the entry point, whereas sometimes surgical intervention is required. MDCTA has proven to be the diagnostic study of choice.

Conclusions:

Aortic dissection is a rare but life‐threatening complication of coronary intervention. Statistical data regarding incidence as well as diagnosis is available for this problem, but exact mechanism of aortic injury, cause and effect relation and preventive measures are yet to be studied. Further research is required to minimize the occurrence of aortic dissection post–cardiac catheterization.

To cite this abstract:

Bajwa M, Chatha I, Farooq S. Iatrogenic Aortic Dissection — a Rare but Lethal Complication of Cardiac Catheterization. Series Case Report. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 500. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/iatrogenic-aortic-dissection-a-rare-but-lethal-complication-of-cardiac-catheterization-series-case-report/. Accessed November 17, 2019.

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