The diagnosis and treatment of acute aortic occlusions

Acute occlusion of the abdominal aorta is infrequently observed. The clinical presentation may vary from acute limb ischaemia, neurologic symptoms of the lower extremities, abdominal symptoms and acute hypertension. This clinical picture is caused by embolic occlusion or, more often, by acute thrombosis. Pre-existing atherosclerosis combined with a low flow state because of poor cardiac performance is a relatively frequent cause of acute aortic occlusion. Hyper-coagulability is observed as well in association with abdominal arteria thrombosis. The management of this condition includes immediate heparinization and measures to improve the cardiac condition. Although operative treatment by thromboembolectomy, aortofemoral bypass or axillofemoral bypass is still most commonly used management, the present treatment of choice probable consists of thrombolytic therapy and mechanical rheolytic thrombectomy followed by stent placement at severely diseased arterial segments. This latter method is associated with a lower mortality than operative therapy in this high risk patient group.