Acute Abdominal Aortic Occlusion Research Articles

Acute Abdominal Aortic Occlusion in a Paraplegic Patient: Case Report

Acute total occlusion of the abdominal aorta is a rare and life-threatening clinical condition. Thrombus is the most common etiology. Associated morbidity and mortality remain high, with high rates of limb loss, acute kidney injury, rhabdomyolysis, and death. Diagnosis is based on the physical examination at the time of presentation. Findings include absent pulses in the lower extremities, pale and cold skin, and neurological deficits. With this case, we aimed to remind that aortic total occlusion, a rare diagnosis, can also be present in patients who present to the emergency department with paraplegia.

Acute abdominal aortic occlusion: A 16-year single-center experience

BackgroundAcute abdominal aortic occlusion (AAO) is a rare vascular emergency associated with high morbidity and mortality. In the present study, we analyzed the clinical management and outcomes for a consecutive patient series during a 16-year period. MethodsWe included all patients with an acute AAO and bilateral acute limb ischemia who had been treated between 2004 and 2019. Patients with dissection, aneurysm rupture, or chronic occlusive disease were excluded. The patient characteristics, surgical procedures, and outcomes were extracted retrospectively from a prospective aortic database, electronic patient files, and outpatient examination records. The extent of ischemia was classified according to the TASC II (Inter-Society Consensus for the Management of Peripheral Arterial Disease) section on acute limb ischemia. The primary endpoints were 30-day mortality (safety endpoint) and the combined 6-month amputation and/or death rate (efficacy endpoint). The follow-up outcomes, amputation rates, and 30-day complications were evaluated as secondary endpoints. The patient cohort was divided into four 4-year groups (2004-2007, 2008-2011, 2012-2015, 2016-2019) to assess the outcome changes over time. Statistical analysis included χ2 tests and univariate and linear regression analyses. ResultsA total of 74 patients (57% male; median age, 64.5 years) with an acute AAO were identified. Arterial thrombosis was the most common etiology (66%). The extent of ischemia was TASC I, IIa, IIb, and III in 7%, 39%, 40%, and 14%, respectively. The patient numbers had increased significantly over time (P = .016). Of the patients, 42% had undergone open transfemoral recanalization (including hybrid procedures), 35% open aortic surgery, 15% extra-anatomic bypass surgery, and 5% (four patients) endovascular therapy alone. The overall 30-day mortality rate was 23%, and the 6-month amputation and/or death rate was 43%. The 30-day mortality rate had declined significantly from 54% for 2004 to 2007 to 10% for 2011 to 2015 (odds ratio [OR], 0.10; 95% confidence interval [CI], 0.001-0.52) and 20% for 2016 to 2019 (OR, 0.21; 95% CI, 0.05-0.90), a statistically nonsignificant trend showing that the relative decline in the use of open aortic procedures was associated with decreased 30-day mortality (P = .06). Univariate analysis indicated that elevated serum lactate on admission (OR, 3.33; 95% CI, 1.06-10.48) and an advanced stage of limb ischemia (OR, 4.33), were strongly associated with an increased 30-day mortality rate. The incidence of severe postoperative systemic complications also indicated a greater incidence of both primary endpoints. The 6-month amputation and/or mortality rates were also affected by the presence of atrial fibrillation (OR, 3.63; 95% CI, 1.34-9.79) and increased patient age (OR, 3.96; 95% CI, 1.49-10.53). ConclusionsAcute AAO remains a life-threatening emergency. Immediate transfemoral open or endovascular techniques should be preferred, if technically possible and proper intraoperative imaging is available.

Acute Abdominal Aortic Occlusion Managed With Covered Stents

A 60-year-old African-American woman with a history of dilated cardiomyopathy and permanent atrial fibrillation presented to the emergency department with acute onset of bilateral lower extremity pain and partial paralysis. History was notable for recent implantable cardioverter-defibrillator

The Role of Extra-Anatomic Bypass in the Surgical Treatment of Acute Abdominal Aortic Occlusion.

BackgroundAortic occlusion is rare catastophic pathology with high rates of mortality and severe morbidity. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extra-anatomic bypass procedures.MethodsEighteen patients who had undergone extra-anatomic bypass interventions in the cardiovascular surgery department of our tertiary care center between July 2009 and May 2013 were retrospectively evaluated. All patients were preoperatively assessed with angiograms (conventional, computed tomography, or magnetic resonance angiography) and Doppler ultrasonography. Operations consisted of bilateral femoral thromboembolectomy, axillobifemoral extra-anatomic bypass and femoropopliteal bypass and were performed on an emergency basis.ResultsIn all patients during early postoperative period successful revascularization outcomes were obtained; however, one of these operated patients died on the 10th postoperative due to multiorgan failure. The patients were followed up for a mean duration of 21.2±9.4 months (range, 6 to 36 months). Amputation was not warranted for any patient during postoperative follow-up.ConclusionTo conclude, acute aortic occlusion is a rare but devastating event and is linked with substantial morbidity and mortality in spite of the recent advances in critical care and vascular surgery. Our results have shown that these hazardous outcomes may be minimized and better rates of graft patency may be achieved with extra-anatomic bypass techniques tailored according to the patient.

A case of acute abdominal aortic occlusion concomitant with gastrointestinal perforation successfully saved by partial thrombectomy and plasma purification

A case of acute abdominal aortic occlusion concomitant with gastrointestinal perforation successfully saved by partial thrombectomy and plasma purification

A Case Report of Acute Abdominal Aortic Occlusion: Successful Treatment with Catheter-directed Thrombolysis

A Case Report of Acute Abdominal Aortic Occlusion: Successful Treatment with Catheter-directed Thrombolysis

Acute Aortic Occlusion by Massive Piling-Up of Large Unstable Thoraco-Abdominal Thrombi Attributable to Heparin-Induced Thrombocytopenia

HomeCirculationVol. 126, No. 3Acute Aortic Occlusion by Massive Piling-Up of Large Unstable Thoraco-Abdominal Thrombi Attributable to Heparin-Induced Thrombocytopenia Free AccessBrief ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessBrief ReportPDF/EPUBAcute Aortic Occlusion by Massive Piling-Up of Large Unstable Thoraco-Abdominal Thrombi Attributable to Heparin-Induced Thrombocytopenia Andre Tomescot, MD and Ioana Ilie, MD Andre TomescotAndre Tomescot From the Department of Thoracic and Vascular Surgery, Bichat University Hospital, Paris, France (A.T.); and the Department of Radiology, Troyes Public Hospital, Troyes, France (I.I.). Search for more papers by this author and Ioana IlieIoana Ilie From the Department of Thoracic and Vascular Surgery, Bichat University Hospital, Paris, France (A.T.); and the Department of Radiology, Troyes Public Hospital, Troyes, France (I.I.). Search for more papers by this author Originally published17 Jul 2012https://doi.org/10.1161/CIRCULATIONAHA.112.102590Circulation. 2012;126:378–379A 64-year-old woman was admitted to the hospital for an acute right leg pain. Clinical examination, revealing a slightly discolored foot with no pedal pulse, went in favor of a limb embolism. Her past medical history was relevant for an endometrial adenocarcinoma treated by radical surgery and adjuvant chemotherapy. The patient confessed being on a 6-week-long course of low-molecular-weight heparin for her port-a-cath occlusion. Subsequent enhanced CT scan showed numerous large aortic mural thrombi (Figure 1). She had a thrombopenia of 120 000 platelets/mL and an anemia of 10g/dL. Her low-molecular-weight heparin was immediately replaced with Danaparoid sodium given the suspicion of heparin-induced thrombocytopenia. A complete aortic thrombectomy under extracorporeal circulation1 and through thoraco-phreno-laparotomy was planned for the very next days after cardiac and pulmonary functions tests could be done.Download figureDownload PowerPointFigure 1. A–C, Sagittal maximum intensity projection (MIP) views depicting numerous mural thrombi stretching over the thoraco-abdominal aorta. They have long nonadherent sides (yellowarrows). D, Three-dimensional image showing patent visceral arteries. Coronal MIP views revealing areas of close proximity between the thrombi.The next day she complained of a sudden abdominal pain paired with tarry vomiting episodes. No femoral pulses were palpated, hypoesthesia and paraparesia of lower extremities and abdominal guarding were found on examination. Abdominal aortic, superior mesenteric, and left renal arteries occlusions attributable to a massive piling up of the mobile mural aortic thrombi were diagnosed on an emergently ordered CT scan (Figure 2). The patient was rushed to the operating room where she underwent transabdominal thrombectomy of the thoraco-abdominal aorta and its tributaries associated with total colonectomy. Large white clots,2 weighing altogether 56 g, were removed from her aorta (Figure 3). Heparin-induced platelet aggregation assay and PF4-polyanion enzyme immunoassay turned out to be positive, confirming the heparin-induced thrombocytopenia. The patient was discharged at day 30 with no renal function impairment or any lower limb vascular or neurological sequelae. Her control CT scan displayed a thoraco-abdominal aorta free of any residual thrombus as well as patent superior mesenteric and left renal arteries (Figure 4). Download figureDownload PowerPointFigure 2. A and B, MIP views showing acute abdominal aortic occlusion by downwards sliding of the dislodged thoracic thrombi as well as left renal and superior mesenteric arteries ostial occlusion. C, Three-dimensional image confirming the occlusion of the aorta by thrombi-accumulation above its bifurcation. Inferior mesenteric artery also appears occluded.Download figureDownload PowerPointFigure 3. All the numerous white clots removed from the aorta. There was no associated fresh blood component in these clots. The largest ones measured >2 inches.Download figureDownload PowerPointFigure 4. Postoperatory CT scan 3-dimensional images showing no residual aortic thrombi and completely patent visceral arteries except right inferior renal polar and inferior mesenteric arteries.DisclosuresNone.FootnotesCorrespondence to Andre Tomescot, MD, Department of Thoracic and Vascular Surgery, Bichat University Hospital, 46 rue Henri Huchard 75018 Paris, France. E-mail [email protected]com

Acute abdominal aortic occlusion mimicking myeleterosis

Acute abdominal aortic occlusion mimicking myeleterosis

Epithelioid Hemangioendothelioma Causing Acute Abdominal Aortic Obstruction and Bilateral Limb Ischemia

A 32-year-old man was admitted with sudden onset of bilateral leg pain. Acute abdominal aortic occlusion was revealed by means of examinations and the patient underwent an emergency operation. Both legs were revascularized following thrombectomy from bilateral femoral arteries and the aorta. Because of the unusual appearance of the emboli, it was sent for pathological examination and was diagnosed epithelioid hemangioendothelioma. Epithelioid hemangioendothelioma is a rare vascular tumor of intermediate malignancy. It usually originates from veins and rarely presents with acute ischemic symptoms.

Acute Aortoiliac and Femoral Artery Thrombosis Complicating Diabetic Ketoacidosis

Acute abdominal aortic occlusion is a devastating event with high associated rates of morbidity and mortality even with surgical intervention. This report describes a case of acute aortoiliac and femoral artery occlusion likely resulting from a hypercoagulable state caused by diabetic ketoacidosis (DKA). Vascular thrombosis is a little-known but potentially devastating complication of DKA that should be considered in every patient treated for DKA and should be added to the differential diagnoses when attempting to determine the etiology of a thrombosed vessel.

Acute abdominal aortic occlusion

Acute occlusion of the infrarenal abdominal aorta is a catastrophic event requiring early recognition and intervention if permanent disability is to be decreased or avoided. While traditional causes of occlusion (saddle embolus and thrombosis) are the most frequent, vasculitis and hypercoagulable states have recently been suggested as etiologies. This article presents three cases of acute abdominal aortic occlusion from different mechanisms and reviews the literature concerning presentation and management.

Prolonged Thrombolysis Followed by Double Balloon Angioplasty for an Abdominal Aortic Occlusion

A 69-year-old woman was admitted with clinical symptoms of an acute abdominal aortic occlusion. Femoral and distal pulses were absent with lower extremity paralysis and loss of sensation. Digital subtraction angiogram confirmed the infrarenal abdominal aortic occlusion. A selective urokinase infusion was initiated from a left brachial approach and continued in conjunction with heparin therapy for 48 hours. Clinical improvement was noted in 24 hours. By 48 hours there was complete abdominal aorta thrombolysis with angiograms revealing bilateral common iliac stenosis. The percutaneous intervention was completed from a brachial approach utilizing conventional (5 French) balloon angioplasty catheters using a double wire “kissing” balloon technique. Following angioplasty, distal pulses were present; the angiograms confirmed patent vessels with excellent distal flow. (J Interven Cardiol 1991; 5:25–27)

鈍的外傷による腹部大動脈閉塞 ｍｙｏｎｅｐｈｒｏｐａｔｈｉｃ ｍｅｔａｂｏｌｉｃ ｓｙｎｄｒｏｍｅに陥った１例

A case of acute abdominal aortic occlusion following blunt trauma is presented. A 39-year-old man was struck in the upper abdomen by the steering wheel of his car when he drove into a guard rail. The patient was admitted to a local hospital for observation, and approximately 5 hours after admission he developed leg pain. He was transferred to our hospital with paraplegia and signs of generalized peritonitis 15 hours after the injury. CT demonstrated pneumoperitoneum, damage to the pancreatic head, and abdominal aortic occlusion 4.5cm below the left renal artery. Laparotomy revealed severe combined pancreatoduodenal injury and complete abdominal aortic occlusion due to subintimal dissection and thrombosis. The injured aorta was excised and replaced with an EPTFE straight graft. Pancreaticoduodenectomy was carried out for the combined pancreatic duodenal injury followed by grafting. However, the patients died of MNMS 11 hours after revascularization. Earlier diagnosis and revascularization could possibly have saved this patient's life by avoiding MNMS from later reperfusion of the ischemic tissue.

3 Cases of Acute Abdominal Aortic Occlusion

3 Cases of Acute Abdominal Aortic Occlusion

Surgical Consideration of Acute Abdominal Aortic Occlusion

Surgical Consideration of Acute Abdominal Aortic Occlusion

Acute abdominal aortic occlusion due to nonpenetrating trauma

A unique report of abdominal aortic occlusion secondary to blunt trauma is described. This is the third reported case, and the second patient successfully treated. The possible mechanisms of injury are discussed. The sudden onset of paraplegia with loss of peripheral pulses in the leg is a dramatic finding which should lead to early diagnosis. Emergency operation with relief of the abdominal aortic occlusion and restoration of blood flow satisfactorily corrects this condition.