Abstract
Disseminated intravascular coagulation (DIC) is a pathological condition involving the systemic activation of the coagulation cascade, leading to the consumption of clotting factors and platelets. Although chronic DIC is a rare complication of aortic aneurysm or dissection, it is still considered life-threatening. Postoperative DIC secondary to endoleaks or stent graft-induced new entry (SINE) poses a therapeutic challenge, often requiring conservative management due to poor general condition and limited surgical options. An 81-year-old woman was admitted due to persistent gastrointestinal bleeding following colon polypectomy. Six months earlier, the patient had undergone thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. A distal SINE was identified 40 days post-TEVAR. As she remained clinically stable, conservative management was initiated. On admission, the laboratory findings met the diagnostic criteria for DIC, including thrombocytopenia, hypofibrinogenemia, and increased fibrinogen degradation products (FDP). The contrast-enhanced computed tomography (CT) imaging revealed persistent inflow from the SINE into the false lumen. Despite transfusions and endoscopic hemostasis, the bleeding persisted. Intravenous nafamostat mesylate was administered, resulting in temporary stabilization. However, due to suspected recurrent DIC from the SINE, definitive endovascular repair was performed using the provisional extension to induce complete attachment (PETTICOAT)-snowshoe technique. Postoperatively, the coagulation parameters worsened but improved with combined anticoagulant and antifibrinolytic therapy. The patient was discharged on postoperative day 40 and remained clinically stable with no recurrence of DIC at 1 year of follow-up. This case highlights the potential usefulness of a combined medical and endovascular approach for managing DIC associated with distal SINE following TEVAR.