Track: Case Reports

Abstract:

Polymer coated medical devices have been increasingly utilized since the 1980s to reduce vascular injury during endovascular procedures. However, detachment of polymer coating can occur intraoperatively, leading to embolization of the material. These emboli may not be readily visible during angiography and can result in significant long-term sequelae, including end organ damage.

We present a case of a 69-year-old male with a thoracoabdominal aortic aneurysm who underwent a fenestrated endovascular aortic repair (FEVAR). Postoperatively, he developed a progressive, purpuric rash localized to the left side of his body that extended from his nipple to his foot. Additional symptoms included fever and left knee swelling. Given clinical concern for septic emboli, dermatology was consulted. A punch biopsy of the left thigh demonstrated embolic basophilic material histologically consistent with polymer emboli reported in the literature.

Polymer emboli have been implicated in ischemic effects on the brain, heart, lungs, and kidneys due to occlusion of small-caliber vessels and an associated inflammatory response. Detection remains a challenge, contributing to underreporting. This case underscores the importance of dermatologic evaluation in the post-operative setting, as cutaneous findings may be the first sign of systemic embolization.

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Ben Petrykowski