| Surgical Treatment of Acute Abdominal
Aortic Occlusion |
(Department of Cardiovascular Surgery, Oita Prefectural
Hospital, Oita, Japan)
| Seiichi Tada |
Kenta Izumi |
Takahumi Yamada |
|
Acute aortic occlusion is an infrequently
observed but frequently fatal event requiring prompt surgical
treatment. We encountered 4 cases of acute non-aneurysmal abdominal
aortic occlusion caused by different mechanisms and reviewed
the literature concerning surgical management. The patients consisted
of 2 men and 2 women with a mean age of 68.7±5.7
years (range, 63 to 75 years). Three of the 4 patients had a
history of atrial fibrillation. Clinical presentations included
acute limb ischemia and neurological deficit in all 4 cases.
The mechanisms of acute aortic occlusion were mainly divided
into embolisms and thrombosis related to aortoiliac occlusive
disease. Operation was done at mean intervals of 8.6 h (range,
5 to 11h). Two patients underwent transfemoral thrombectomy under
local anesthesia, one thromboendarterectomy under laparotomy
on hemodialysis, and one axillobifemoral bypass procedure. One
patient had to undergo fasciotomy immediately because of compartment
syndrome, 2 other patients needed additional procedures (one
had femoro-popliteal bypass and the other had mitral valve replacement).
The perioperative mortality rate was 25%, related to massive
cerebral infarction. The outcomes of these patients depend on
prompt diagnosis, systemic heparinization and early revascularization
by appropriate operation; initial attempt of transfemoral thrombectomy,
and axillobifemoral bypass in high risk patients. After revascularization,
patients must be carefully monitored for reperfusion syndrome,
myonephropathic metabolic syndrome, acute renal failure and compartment
syndrome.
Jpn. J. Cardiovasc. Surg. 33: 375-381 (2004) |
|
