ACUTE AORTIC OCCLUSION - FACTORS THAT INFLUENCE OUTCOME

Purpose: The purpose of this study was to report our experience in the management of acute aortic occlusion and to analyze factors that infl uenced the outcome. Methods: This was a retrospective analysis of 48 p atients with acute aortic occlusion treated over a 19-year period. Pre sentation included limb ischemia in 34, acute abdomen in four, spinal cord compression-like symptoms in eight, and sudden onset of hypertens ion in two patients. Thrombosis was the cause of acute aortic occlusio n in 44, and embolus in four patients. Acute thrombosis was associated with underlying atherosclerotic occlusive disease in 36 patients. In these, thrombosis was due to low-flow state caused by cardiac dysfunct ion or severe volume depletion. Thrombosed aneurysms caused aortic occ lusion in two patients. Hypercoagulable state caused thrombosis of rel atively normal aorta in six patients. Angiography in 39 patients revea led occlusion to be juxtarenal or infrarenal in 37 and suprarenal in t wo. Left ventricular function (LVF) was assessed in 42 patients. Circu lation was restored in 45 (aortofemoral bypass in 22, axillofemoral by pass in 12, and thromboembolectomy in 11). This was not feasible in th ree patients. Additional surgical procedures were required in 29 patie nts (64%). Results: The overall mortality rate was 52% (25 of 48). Of the 20 patients with severely compromised LVF, 17 died (85%). In contr ast, only five (23%) deaths occurred among 22 with good LVF. Among 29 patients who required additional operations, 18 died (62%). All four p atients with embolic occlusion survived. Patients with normal LVF but hypercoagulable state had dismal outcome-only one of the six survived. Conclusions: Acute aortic occlusion is infrequent. Presentation may b e varied, thus delaying diagnosis. Poor LVF, thrombosis of arteries be low the inguinal ligament or of visceral arteries, and ''hypercoagulab le state'' portend ominous prognosis.