ACUTE OCCLUSION OF THE ABDOMINAL-AORTA

BACKGROUND: Acute aortic occlusion most commonly results from aortic s addle embolus or thrombosis of an atherosclerotic abdominal aorta. The purpose of this study was to review the experience at a university ho spital to better define the diagnosis and management of this uncommon process. METHODS: A retrospective chart review was performed from pati ents admitted to Emery University Hospital with acute occlusion of the abdominal aorta from 1985 through 1997. RESULTS: Thirty-three patient s were identified. In group EMB (n = 16), occlusion was due to saddle embolus. In group IST (n = 17), occlusion was attributed to in situ th rombosis of a severely diseased aorta. Operative procedures performed included transfemoral embolectomy (15), aortobifemoral bypass (9), axi llobifemoral bypass (5), fasciotomy (3), and thrombolysis (1). The in- hospital mortality rate was 21% (31% EMB, 12% IST), and morbidity was significant and included mesenteric ischemia (6%), bleeding complicati ons (9%), subsequent amputation (12%), renal failure (15%), recurrent embolization or thrombosis (21%), and cardiac complications (42%). CON CLUSIONS: Acute aortic occlusion has tremendous morbidity and mortalit y even with optimal surgical care. Am J Surg. 1998;176:193-197. (C) 19 98 by Excerpta Medica, Inc.