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Distal embolization as a presenting symptom of aortic aneurysms
B T Baxter1, G S McGee, W R Flinn
1Department of Surgery, Northwestern University Medical School, Chicago, Illinois.
American Journal of Surgery
|August 1, 1990
Summary
Distal embolization from abdominal aortic aneurysms (AAA) can be the first sign of disease, causing severe limb ischemia. Even small AAAs pose a significant risk, with outcomes comparable to ruptured aneurysms.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Aortic Aneurysm Disease
Background:
- Abdominal aortic aneurysm (AAA) repair is a common vascular procedure.
- Distal embolization is a less common but serious initial presentation of AAA.
- Understanding the risks and outcomes associated with embolic AAA is crucial.
Purpose of the Study:
- To analyze the presentation, diagnosis, and outcomes of patients with AAA presenting with distal embolization.
- To compare the diagnostic utility of CT scan versus angiography in these cases.
- To evaluate the morbidity and mortality associated with AAA presenting with emboli.
Main Methods:
- Retrospective review of 302 patients undergoing AAA repair (1985-1990).
- Focus on 15 patients (5%) presenting with distal embolization.
- Analysis of diagnostic imaging (CT scan, angiography), surgical repair methods, and complications.
Main Results:
- Fifteen patients presented with distal embolization, leading to limb ischemia, digital ischemia, or myonecrosis.
- CT scan was more informative than angiography and safer.
- Morbidity for embolic AAA was comparable to ruptured AAA, with high rates of amputation and renal failure.
Conclusions:
- Distal embolization is a critical presentation of AAA, regardless of aneurysm size.
- Patients with embolic AAA face significant morbidity, similar to those with ruptured aneurysms.
- CT scan is the preferred imaging modality for diagnosing AAA with embolic events.