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Introduction: Endoleak-associated DIC is an understudied condition with potentially overlapping symptoms that can increase difficulty of diagnosing and managing patients, especially in patients with comorbid conditions such as renal failure.

Case report: A 79-year-old female with significant past medical and surgical histories of stage V chronic kidney disease and abdominal aortic and right external iliac artery aneurysms status-post endovascular presented to an academic hospital for urgent dialysis catheter placement due to end-stage renal disease (ESRD) with symptoms of hypervolemia, electrolyte abnormalities and pancytopenia. Nephrology was consulted on admission. Temporary catheter was placed without complication however patient continued to bleed from that site. Initially, there was suspicion for uremic thrombocytopenia; however, despite tolerating multiple dialysis sessions, patient continued to bleed even after receiving platelet transfusions. Vascular surgery was unable to stop the bleeding. Additional workup revealed abnormal coagulation panel, including low fibrinogen. Hematology was consulted, concerning for possible malignancy, immune thrombocytopenic purpura, or disseminated intravascular coagulopathy (DIC). CT abdomen revealed type I endoleak (6.5 cm in diameter) at proximal bilateral common iliac arteries. Cryoprecipitate was given due to low fibrinogen, secondary to endoleak-associated DIC. The bleeding subsequently stopped and patient was discharged with appropriate outpatient appointments including dialysis and vascular surgery.

Conclusion: which has overlapping symptoms with many diseases in …