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Acute aortic occlusion. A 40-year experience
C D Dossa1, A D Shepard, D J Reddy
1Department of Surgery, Henry Ford Hospital, Detroit, Mich.
Insights
Acute aortic occlusion (AAO) is a serious vascular emergency. Embolism is the main cause, and while survivors have a good long-term outlook, permanent anticoagulation is recommended for embolic cases.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Emergency Medicine
Background:
- Acute aortic occlusion (AAO) is a critical vascular condition requiring prompt diagnosis and management.
- Understanding the causes, risk factors, and outcomes of AAO is crucial for improving patient care.
Purpose of the Study:
- To define the causes, clinical presentation, treatment, prognostic variables, and outcomes of acute aortic occlusion.
- To analyze a large patient cohort over a significant period to identify trends and improve understanding of AAO.
Main Methods:
- Retrospective review of 46 adult patients diagnosed with acute aortic occlusion over 40 years.
- Data collected included arteriographic/operative confirmation, clinical presentation, treatment (operative/nonoperative), and outcomes (mortality, morbidity, survival).
Main Results:
- Embolism (65%) and thrombosis (35%) were the primary causes of AAO.
- Risk factors included heart disease/female gender for embolism, and smoking/diabetes for thrombosis. Ischemia severity predicted outcome better than duration.
- Hospital mortality was 35%, morbidity 74%. Recurrent embolism occurred in 43% of embolic AAO patients. 5-year survival for survivors was 72%.
Conclusions:
- AAO is a severe vascular emergency with high morbidity and mortality, despite appropriate treatment.
- Survivors of AAO experience a reasonable long-term prognosis.
- Permanent anticoagulation is recommended for embolic AAO to reduce recurrent embolism rates.
Objective:
To review a large experience with acute aortic occlusion (AAO) to better define the cause, clinical presentation, treatment, prognostic variables, and outcome.
Design:
Retrospective review of 46 consecutive patients with AAO during a 40-year period.
Setting:
A large urban tertiary care referral center in Detroit, Mich.
Patients:
Adult patients with arteriographic and/or operative confirmation of acute occlusion of the abdominal aorta plus signs and symptoms of acute ischemia.
Intervention:
Operative and nonoperative treatment of AAO.
Main Outcome Measures:
Mortality, morbidity, and long-term survival. Other variables measured included cause, risk factors, and effects of duration and severity of ischemia and treatment methods on outcome.
Results:
Two primary causes were identified--embolism (65%) and thrombosis (35%). Heart disease and female gender were risk factors for embolism, while smoking and diabetes were risk factors for thrombosis. Severity of ischemia on presentation correlated better with outcome than duration of ischemia. The hospital mortality rate was 35% and morbidity, 74%, with no difference between the two groups. Recurrent arterial embolism occurred in 43% of patients with embolic AAO. Seventy-two percent of AAO survivors were alive 5 years after therapy.
Conclusions:
Acute aortic occlusion remains a serious vascular surgical emergency with significant morbidity and mortality, even when recognized promptly and treated appropriately. Nevertheless, survivors have a reasonable long-term outcome. Permanent anticoagulation is suggested in patients with embolic AAO to minimize a high incidence of recurrent arterial embolism.