A Modern Series of Acute Aortic Occlusion

Abstract

Acute aortic occlusion (AAO) is rare with the last large series published in 1998 which included patients dating back to the 1980’s. These studies report that 50% of AAOs secondary to embolization with an approximate mortality rate of 50%. We reviewed our recent experience with AAO to identify current etiologies and outcomes in a modern era. CPT codes were used to identify patients with AAO from 2005-2012 from a prospectively maintained surgical database. AAOs secondary to trauma, dissection or endograft occlusion were excluded. We identified 22 patients with AAO as outlined in Table. Seventeen presented with isolated occlusion and five with occlusion extending above the renal arteries. Significant lower extremity neurologic deficits were noted in 12 patients, six with complete paralysis. Mean time from symptom onset to diagnosis was 36 hours (range, 6-72 hours). 16 (73%) presented to our institution as a transfer. Etiology was aortoiliac thrombosis in 17 (77%) cases, embolic occlusion in 1, and indeterminate in 4. Extra-anatomic bypass was performed in 14 patients, thromboembolectomy in 4 and aortobifemoral bypass in 3. One patient died prior to intervention. Acute renal failure developed in 14 patients (68%) and eight had rhabdomyolysis. Fasciotomy was performed in 14 (68%) extremities and nine extremities required amputation (41%). All cause mortality was 41% with all deaths occurring within 3 months of AAO. AAO is an infrequent but devastating event. Our experience demonstrates that the etiology of AAO the etiology has shifted from embolic to aortoiliac thrombosis. Despite advances in vascular surgery over the past decades, however, the morbidity and mortality remain significant with a high rate of limb loss, acute renal failure, rhabdomyolysis and death. Contributing factors to poor outcomes continue to be delays in diagnosis and the need for highly skilled tertiary centers.TablePatient characteristicsN = 22 (%)Median age at diagnosis66.8Male12 (55)PAD13 (59)CAD13 (59)CVA/TIA5 (23)HTN17 (77)CHF5 (23)Diabetes9 (41)Smoker16 (76)Thrombophilia5 (23)Atrial fibrillation4 (18) Open table in a new tab