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"Bailout" Endovascular Treatment of Acute Aortic Occlusion
Konstantinos Tigkiropoulos1, Kyriakos Stavridis1, Ioannis Lazaridis1
1Vascular Unit, 1st Department of Surgery, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Insights
A patient with a history of heart attack experienced lower limb ischemia due to aortic blockage. Successful treatment involved aortic stenting and left ventricle thrombectomy, followed by anticoagulant therapy.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Surgery
Background:
- A 37-year-old male with recent acute myocardial infarction (AMI) presented with acute lower limb ischemia.
- CT aortography revealed left ventricle thrombi and acute thromboembolic occlusion of the aortoiliac bifurcation.
Observation:
- Initial Fogarty embolectomy for aortic bifurcation occlusion was unsuccessful.
- The patient required urgent surgical intervention for limb salvage and cardiac thrombus removal.
Findings:
- Primary deployment of balloon-expandable (BE) covered stents in the aortic bifurcation was performed.
- Left ventricle (LV) thrombectomy under extracorporeal circulation was successfully completed 2 days post-aortic intervention.
Implications:
- This case highlights a complex presentation of embolic occlusion secondary to left ventricle thrombi post-AMI.
- Combined endovascular and surgical management can be effective in limb-threatening ischemia due to aortoiliac occlusion and LV thrombus.
Abstract:
A 37-year-old man who had a recent history of acute myocardial infarction (AMI) 3 months ago presented to the emergency department with acute ischemia of lower limbs. A CT aortography was performed, where left ventricle thrombi and acute thromboembolic occlusion of aortoiliac bifurcation were depicted. He was urgently transferred to the operation theatre, where Fogarty embolectomy was initially unsuccessful. He was managed by primary deployment of balloon expandable (BE) covered stents in the aortic bifurcation followed by thrombectomy of the left ventricle (LV) under extracorporeal circulation by cardiothoracic surgeons 2 days after initial operation. He was discharged in good general condition after 20 days under warfarin and aspirin therapy.