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Surgical management of atheroembolization
R R Keen1, W J McCarthy, P K Shireman
1Department of Surgery, Northwestern University Medical School, Chicago, IL, USA.
Journal of Vascular Surgery
|May 1, 1995
Summary
Surgical treatment of atheroembolism from the aorta or iliac arteries offers good outcomes. However, extensive suprarenal aortic thrombus presents a higher risk for mortality and limb loss.
Area of Science:
- Vascular Surgery
- Cardiovascular Disease
- Interventional Radiology
Background:
- Atheroembolization is a serious condition that can lead to limb loss or organ failure.
- Surgical outcomes for atheroembolization are not well-documented.
- This study presents the largest series of atheroembolization cases, focusing on disease patterns, surgical interventions, and patient outcomes.
Purpose of the Study:
- To analyze the patterns of disease in atheroembolization.
- To evaluate the effectiveness of surgical treatments for atheroembolization.
- To report the outcomes of surgical intervention for atheroembolization.
Main Methods:
- A prospective study of 100 patients (70 men, mean age 62) undergoing surgery for atheroemboli in the lower extremities, visceral organs, or upper extremities over 12 years.
- Atheroembolic source localization using computed tomography (CT) scanning, arteriography, duplex scanning, transesophageal echocardiography, and magnetic resonance imaging (MRI).
- Surgical correction methods included aortic bypass, endarterectomy with patch, infrainguinal bypass, extraanatomic reconstruction, graft revision, and upper extremity procedures.
Main Results:
- Occlusive aortoiliac disease and small aortic aneurysms were the most common sources of atheroemboli.
- Patients with extensive suprarenal aortic thrombus (12 patients) had significantly higher mortality rates (all 7 early deaths occurred in this group).
- Overall survival rates at 1, 3, and 5 years were 89%, 83%, and 73%, respectively. Postoperative complications included major leg amputations (9), toe amputations (10), and hemodialysis for renal involvement (10). Recurrent embolic events were infrequent (5/97) and primarily occurred early post-operatively, with a trend towards fewer recurrences in patients not on warfarin.
Conclusions:
- The aorta and iliac arteries are the primary sources of atheroemboli in surgically treated patients.
- CT scanning of the aorta is a valuable diagnostic tool for identifying the embolic source.
- Surgical elimination of the embolic source is associated with low mortality and limb loss rates, except in cases involving the suprarenal aorta.