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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 1, January/February 2016
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AFRICA
This fibrinolytic process in IMMD is distinct from DIC.
2
Patients with IMMD are found to have decreased levels of
platelets and fibrinogen, as well as factors V and VIII.
2
This leads
to accelerated fibrinolysis, often manifest as reduced euglobulin
lysis time.
2
In contrast to DIC, positive fibrin monomer and
increased D-dimer levels are not seen in IMMD.
2,6,8
The surgical
team needs to be aware of the bleeding tendency of patients
with IMMD.
6
Also, the arterial wall often appears friable with a
tendency to dissect easily during suture repair. Meticulous suture
technique is therefore essential.
6,8
The coagulation profile and
platelet function should be carefully monitored peri-operatively
and diligently corrected.
8
A single case report by Katz
et al
. describes endovascular
repair of a gluteal artery aneurysm secondary to IMMD.
2
However, the standard of care in the treatment of IMMD-
related aneurysms is open surgical repair.
6,8
At our institution,
we have treated a few patients with IMMD-related thoraco-
abdominal aneurysms with hybrid procedures, comprising
visceral debranching and revascularisation followed by extensive
thoraco-abdominal stent grafting.
The prognosis depends on the extent of disease and the time
of presentation.
8
Acute presentation with dissection has higher
morbidity and mortality rates.
8
Adverse outcomes are related
to major blood loss requiring massive blood transfusions and
the associated complications, as well as multi-organ failure
secondary to shock.
6
At the time of submission for publication, this case report
possibly represents the first described case of IMMD affecting
the renal artery.
Conclusion
Although IMMD is a rare vascular disorder, it forms part of
the differential diagnoses in aortic aneurysm, especially in the
younger population and in the absence of conventional risk
factors associated with non-specific degenerative aneurysms.
Clinicians managing patients with IMMD should be aware of
the bleeding diathesis associated with this condition.
The authors thanks Ms Monica van Schalkwyk for her help in obtaining the
articles reviewed in this case report.
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