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Published on: August 24, 2018
Temporal Trends and Management of Acute Aortic Occlusion: A 21 Year Experience
Olivia Grip1, Anders Wanhainen1, Martin Björck1
1Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
Insights
Surgical treatment outcomes for acute aortic occlusion (AAO) show improving mortality rates over time. However, the incidence of AAO due to occluded grafts, stents, or stent grafts has increased, highlighting a shift in underlying causes.
Area of Science:
- Vascular Surgery
- Cardiovascular Research
- Public Health Epidemiology
Background:
- Acute aortic occlusion (AAO) is a rare, life-threatening vascular emergency.
- Understanding population-based outcomes of surgical AAO treatment is crucial for improving patient care.
Purpose of the Study:
- To analyze the incidence and outcomes of surgical treatment for acute aortic occlusion (AAO) in a nationwide population-based cohort.
- To identify trends in the etiology of AAO and associated mortality over a 21-year period.
Main Methods:
- Utilized the Swedish nationwide vascular database (Swedvasc) for case identification and the population registry for long-term survival analysis.
- Employed chi-square tests and analysis of variance to assess variables associated with patient outcomes.
Main Results:
- A total of 693 surgical AAO cases were analyzed from 1994-2014, with an incidence of 3.6 per million inhabitants.
- Native artery thrombosis was the most common cause (66.1%), but occluded grafts/stents/stent grafts increased significantly over time (6.7% to 17.4%).
- Thirty-day mortality decreased from 25.5% to 15.5% over the study period, with variations based on AAO etiology.
Conclusions:
- Surgical treatment for AAO demonstrates improving mortality rates over time.
- A notable increase in AAO cases attributed to occluded grafts, stents, or stent grafts was observed.
- Despite improvements, AAO remains associated with significant mortality, necessitating continued research and preventative strategies.
Objectives:
The aim was to study patients with acute aortic occlusion (AAO), a rare and life threatening event, in a population based cohort and the outcome of surgical treatment.
Methods:
The Swedish nationwide vascular database (Swedvasc) was used to identify cases, and the population registry to study long term survival. Variables associated with outcome were tested with the chi-square test and analysis of variance.
Results:
During the 21 year study period (1994-2014), 693 cases of surgical treatment for AAO were included, with a yearly incidence of 3.6 per million inhabitants. Mean ± SD age was 69.9 ± 11.2 years, 352 patients (50.8%) were women, and mean ± SD length of follow up was 5.2 ± 5.5 years. Most patients presented with bilateral acute limb ischaemia (596 patients, 86.0%). The aetiology of AAO was native artery thrombosis in 458 patients (66.1%), saddle embolus in 152 (21.9%), and occluded graft/stent/stent grafts in 83 (12.0%). The proportion of occluded grafts/stent/stent grafts increased during the study period (n = 14 [6.7%] in 1994-2000 vs. n = 45 [17.4%] in 2008-2014; p < .001) with a simultaneous reduction of arterial thrombosis (n = 149 [71.6%] in 1994-2000 vs. n = 158 [61.2%] in 2008-2014; p <. 001). Major amputation above the ankle was performed in 39 patients (8.5%), and 140 patients died within 30 days of surgery (20.2%). Thirty day mortality rate was lower after occluded grafts/stents/stent grafts (eight patients [9.6%]) and higher after saddle embolus (47 patients [30.9%]); p < .001). There was a reduction in overall 30 day mortality over time (n = 53 [25.5%] in 1994-2000 vs. n = 40 [15.5%] in 2008-2014; p = .007). Long term survival revealed significant differences between the subgroups, although the difference occurred early after the event (p < .001).
Conclusions:
Mortality after surgical treatment of AAO is improving over time, yet a significant mortality rate was observed throughout the study period. The proportion of AAO secondary to occluded grafts/stents/stent grafts increased over time.
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