[Acute occlusions of the aorta]

Acute occlusion of the aorta is a vascular emergency with high mortality, greater than 30% after revascularization, due to the extent of the ischaemic territory and the haemodynamic consequences. Over a period of 12 years, 34 patients (22 males, 12 females) underwent surgery for acute occlusion of the aorta. Acute bilateral ischaemia was present in 24, unilateral ischaemia in 6 and sub-acute ischaemia in 4. An embolus of cardiac origin was the cause in 13 cases, disease of the aorta itself in 11 cases and hypercoagulability in 10 including 7 due to allergy to heparin. The delay from onset of ischaemia to revascularization was 9 hours (mean). Revascularization was done by simple bifemoral embolectomy in 19 cases, by aortobifemoral bypass in 9 and by extra-anatomic bypass in 6 (3 supra-pubic, 3 axillo-bifemoral). Six patients (18%) died during the post-operative period. Delay to care had been greater than 12 hours in most of these patients. One or more post-operative complications occurred in 18 patients (53 p. 100) including repeated thrombosis, insufficient revascularization, ischaemic neuropathy. Long-term survival at 3 years was 30%. Prognosis might be improved by three elements: reducing the duration of ischaemia by rapid diagnosis and emergency revascularization, better control of metabolic disorders, screening for heparin allergy before thrombotic events occur.