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We report the case of a 70-year-old woman who underwent total arch replacement with frozen elephant trunk implantation. Postoperatively, she developed DIC complicated by acute kidney injury and cerebral infarction. Contrast-enhanced computed tomography revealed the reverse rim sign, indicating renal cortical necrosis. Ultimately, irreversible renal failure necessitated maintenance hemodialysis. DIC associated with aortic dissection can lead to multi-organ failure from systemic microthrombosis and requires vigilant monitoring.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf793","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:51:33Z","timestamp":1760035893000},"source":"Crossref","is-referenced-by-count":1,"title":["A case of renal cortical necrosis likely caused by disseminated intravascular coagulation after acute type A aortic dissection repair"],"prefix":"10.1093","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3914-1384","authenticated-orcid":false,"given":"Kotaro","family":"Mukasa","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Chiba Cardiovascular Center , Ichihara 290-0512 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasunori","family":"Yakita","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Chiba Cardiovascular Center , Ichihara 290-0512 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryosuke","family":"Marushima","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Chiba Cardiovascular Center , Ichihara 290-0512 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shinichiro","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Chiba Cardiovascular Center , Ichihara 290-0512 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soichi","family":"Asano","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Chiba Cardiovascular Center , Ichihara 290-0512 ,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"2025100914512747500_ref1","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/0002-9343(75)90351-4","article-title":"Coagulopathy in ruptured or dissecting aortic aneurysms","volume":"59","author":"Ten Cate","year":"1975","journal-title":"Am J Med"},{"key":"2025100914512747500_ref2","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1093\/ejcts\/ezv045","article-title":"Aortic remodelling in aortic dissection after frozen elephant trunk","volume":"49","author":"Dohle","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025100914512747500_ref3","doi-asserted-by":"publisher","first-page":"7007","DOI":"10.2147\/IJGM.S330325","article-title":"Risk factors for postoperative mortality in patients with acute Stanford type a aortic dissection","volume":"14","author":"Huo","year":"2021","journal-title":"Int J Gen Med"},{"key":"2025100914512747500_ref4","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/0002-9343(74)90756-6","article-title":"Acute cortical necrosis. Case report and review of the literature","volume":"56","author":"Matlin","year":"1974","journal-title":"Am J Med"},{"key":"2025100914512747500_ref5","doi-asserted-by":"publisher","first-page":"176","DOI":"10.2214\/ajr.137.1.176","article-title":"CT appearance of acute renal cortical necrosis","volume":"137","author":"Goergen","year":"1981","journal-title":"AJR Am J Roentgenol"},{"key":"2025100914512747500_ref6","doi-asserted-by":"publisher","first-page":"480","DOI":"10.5527\/wjn.v4.i5.480","article-title":"Changing picture of renal cortical necrosis in acute kidney injury in developing country","volume":"4","author":"Prakash","year":"2015","journal-title":"World J Nephrol"},{"key":"2025100914512747500_ref7","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s13613-021-00842-4","article-title":"Efficacy and safety of human soluble thrombomodulin (ART-123) for treatment of patients in France with sepsis-associated coagulopathy: post hoc analysis of SCARLET","volume":"11","author":"Fran\u00e7ois","year":"2021","journal-title":"Ann Intensive Care"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/10\/rjaf793\/64601867\/rjaf793.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/10\/rjaf793\/64601867\/rjaf793.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:51:34Z","timestamp":1760035894000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjaf793\/8280137"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":7,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,9,30]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjaf793","relation":{},"ISSN":["2042-8812"],"issn-type":[{"value":"2042-8812","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,10]]},"published":{"date-parts":[[2025,9,30]]},"article-number":"rjaf793"}}