A retrospective review was done of all patients undergoing surgical repair of
abdominal aortic aneurysm (AAA) on whom coagulation studies were obtained. Those patients with laboratory documented
disseminated intravascular coagulation (
DIC) were selected and their clinical records reviewed. This included 7 patients studied in the periods 1964-1965 and January 1971-July 1973. Of these 7 cases, 4 occurred in patients undergoing emergency operation for
ruptured aneurysm and 3 were in elective cases. All 7 patients exhibited clinical evidence of abnormal
bleeding, while 6 of the 7 progressed rapidly to renal shutdown. The seventh patient recovered spontaneously. Of the 6 patients with full blown clinical and laboratory evidence of
DIC, 2 recovered. Both cases received
heparin therapy and multiple
hemodialyses. A third patient was started on
heparin but died at 36 hours in
heart failure. All 3 patients receiving
heparin showed clinical cessation of abnormal
bleeding and disappearance of soluble
fibrin monomer complexes within 24 hours of starting
therapy. The study suggests a higher incidence of
DIC than has previously been appreciated in both the emergency and elective repair of AAA. The prompt recognition and treatment of this complication may reverse the abnormal intravascular clotting, minimize its more serious results and avoid futile and dangerous operative intervention.