SUPRARENAL AORTIC OCCLUSION

Purpose: This report was designed to elucidate the clinical manifestat ions of suprarenal aortic occlusion (SRAO) and determine the efficacy of surgical treatment. Methods: A retrospective review of 13 5 patient s with aortic occlusion was undertaken from which the 16 patients (12% ) with SRAO were found. Results: Analysis yielded two subsets of patie nts based on the time-frame over which SRAO developed. Group I (n = 13 ) had chronic aortic occlusion with proximal propagation of thrombus t o involve the suprarenal aorta. They had uncontrolled hypertension and claudication. Surgical treatment included 16 renal reconstructions (n ine patients), two nephrectomies, 10 aortobifemoral bypasses, and thre e extra-anatomic procedures. The operative mortality rate was 23%. In contrast, group II (n = 3) had acute SRAO, manifest by profound lower extremity ischemia and acute renal failure after cardiac dysrhythmias. Two patients were moribund and died shortly after extraanatomic ''sal vage'' procedures. One patient survived aortobifemoral and bilateral r enal artery bypass. Conclusion: Chronic SRAO should be suspected in pa tients with absent femoral pulses and refractory hypertension. Aortic and renal reconstruction offers long-term improvement in hypertension control and relief of claudication. Acute SRAO is a multisystem disord er that is ineffectively managed with extraanatomic ''salvage'' proced ures.