A Man with Sudden Onset Leg Pain and Weakness
James DeChiara1, Lisa Skinner2
1Madigan Army Medical Center, Department of Emergency Medicine, Joint Base Lewis-McChord, Washington.
Insights
This case report details a rare vascular emergency: acute aortic occlusion. Prompt diagnosis and surgical intervention, including embolectomies and stenting, successfully restored function in an elderly patient.
Area of Science:
- Vascular Surgery
- Emergency Medicine
- Cardiology
Background:
- Acute aortic occlusion is a rare but life-threatening vascular emergency.
- It can be misdiagnosed as spinal pathology, leading to delayed treatment.
- High morbidity and mortality rates are associated with this condition.
Purpose of the Study:
- To present a case of acute aortic occlusion in an elderly patient.
- To highlight the diagnostic challenges and successful management of this condition.
Main Methods:
- A case presentation of an 89-year-old male with sudden leg pain and weakness.
- Diagnosis confirmed by computed tomography angiography showing acute aortic and iliac artery occlusion.
- Surgical intervention included aortoiliac and femoral embolectomies and bilateral common iliac artery stenting.
Main Results:
- The patient underwent successful embolectomies and stenting.
- The patient returned to his baseline functional status post-intervention.
Conclusions:
- Acute aortic occlusion requires prompt diagnosis and intervention to improve outcomes.
- Despite its rarity, it remains a critical vascular emergency with significant risks.
- Multimodal imaging and surgical expertise are crucial for effective management.
Case Presentation:
An 89-year-old male who had been holding dabigatran in the setting of transcarotid artery revascularization presented to the emergency department with sudden onset leg pain and weakness. Computed tomography angiography revealed acute aortic occlusion and thrombosis of the bilateral common iliac arteries. He underwent aortoiliac and femoral embolectomies and stenting of the bilateral common iliac arteries and returned to his baseline functional status.
Discussion:
Acute aortic occlusion is a rare but often devastating vascular emergency characterized by obstruction of the aorta by an embolus or thrombosis. Diagnosis can be challenging as it may be mistaken for spinal pathology, which can lead to delays in diagnosis. Despite advances in diagnostic modalities and interventions, acute aortic occlusion often results in high rates of major morbidity and mortality.
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