Disseminated atheroembolism from extensive degenerative atherosclerosis of the aorta

The surgical management of disseminated atheroembolism was studied in seven patients. The diagnosis of disseminated atheroembolism from extensive degeneration of the thoracic and abdominal aorta was based on clinical evidence of cutaneous atheroembolism, angiographic demonstration of irregular aortic plaques, and findings of cholesterol emboli in tissue specimens. All patients had severe cardiopulmonary disease. In four cases treatment consisted of palliative axillobifemoral bypass with ligation of the external iliac arteries to exclude the proximal aortic source of emboli to the feet. Three patients underwent intestinal resection for visceral atheroembolism. Permanent access for hemodialysis was required in four patients. All patients died within 6 months of the diagnosis of disseminated atheroembolism. Surgical therapy has three roles in disseminated atheroembolism: prevention of further atheroembolism with its attendant peripheral or visceral organ damage; amputation or resection of irretrievably damaged tissue; and provision of chronic hemodialysis access. The optimal treatment is thoracoabdominal reconstruction of the aorta. In the high-risk patient, axillobifemoral bypass with iliac ligation may be used to treat recurrent painful atheroembolism to the feet. Continuing atheroembolism to the visceral and pelvic circulation, renal failure, and progressive asthenia are associated with the poor prognosis of patients with this disease.