Acute aortic occlusion.

Abstract

Acute aortic occlusion is a rare and emergent vascular event. Patients who present with this disorder have a classical history and physical examination consistent with occlusion of the distal aorta and resultant ischemia to the distal tissues. Time is of the essence in dealing with these patients. Aortography proved to be important in determining renal artery involvement in our patients. Based on this finding, we suggest that preoperative arteriograms be obtained. The method of treating these patients after arteriography should be to move quickly to the operating room. Patients with renal artery occlusion must be seriously considered for primary revascularization with either aortofemoral or aortoiliac reconstruction and thrombectomy or bypass of the occluded renal artery. If no renal artery involvement is revealed on arteriography, the initial operation should include an attempt to reestablish inflow by retrograde femoral thromboembolectomy under local anesthesia. If that fails, a decision must be made based on the patient's clinical status, whether a major vascular procedure would be tolerated. If so, primary revascularization or transabdominal thrombectomy should be attempted. If the patient is deemed unable to tolerate a major vascular procedure, then axillobifemoral bypass under local anesthesia should be performed. Postoperatively, the patient should be aggressively managed to prevent pulmonary and renal complications. Even with aggressive surgical management and postoperative care, these patients have an uncertain postoperative course. It is of primary importance that physicians realize that time is a critical factor and these patients must be referred to the appropriate care center promptly. Only by ensuring prompt surgical management can a mortality rate of less than 50 percent be expected.