Suprarenal aortic occlusion.

Abstract

PURPOSE: This report was designed to elucidate the clinical manifestations of suprarenal aortic occlusion (SRAO) and determine the efficacy of surgical treatment. METHODS: A retrospective review of 135 patients with aortic occlusion was undertaken from which the 16 patients (12%) with SRAO were found. RESULTS: Analysis yielded two subsets of patients based on the time-frame over which SRAO developed. Group I (n = 13) had chronic aortic occlusion with proximal propagation of thrombus to involve the suprarenal aorta. They had uncontrolled hypertension and claudication. Surgical treatment included 16 renal reconstructions (nine patients), two nephrectomies, 10 aortobifemoral bypasses, and three extra-anatomic procedures. The operative mortality rate was 23%. In contrast, group II (n = 3) had acute SRAO, manifest by profound lower extremity ischemia and acute renal failure after cardiac dysrhythmias. Two patients were moribund and died shortly after extraanatomic "salvage" procedures. One patient survived aortobifemoral and bilateral renal artery bypass. CONCLUSION: Chronic SRAO should be suspected in patients with absent femoral pulses and refractory hypertension. Aortic and renal reconstruction offers long-term improvement in hypertension control and relief of claudication. Acute SRAO is a multisystem disorder that is ineffectively managed with extraanatomic "salvage" procedures.