ACUTE AORTIC OCCLUSION - A 40-YEAR EXPERIENCE

Objective: To review a large experience with acute aortic occlusion (A AO) to better define the cause, clinical presentation, treatment, prog nostic variables, and outcome. Design: Retrospective review of 46 cons ecutive patients with AAO during a 40-year period. Setting: A large ur ban tertiary care referral center in Detroit, Mich. Patients: Adult pa tients with arteriographic and/or operative confirmation of acute occl usion of the abdominal aorta plus signs and symptoms of acute ischemia . Intervention: Operative and nonoperative treatment of AAO. Main Outc ome Measures: Mortality, morbidity, and long-term survival. Other vari ables measured included cause, risk factors, and effects of duration a nd severity of ischemia and treatment methods on outcome. Results: Two primary causes were identified-embolism (65%) and thrombosis (35%). H eart disease and female gender were risk factors for embolism, while s moking and diabetes were risk factors for thrombosis. Severity of isch emia on presentation correlated better with outcome than duration of i schemia. The hospital mortality rate was 35% and morbidity, 74%, with no difference between the two groups. Recurrent arterial embolism occu rred in 43% of patients with embolic AAO. Seventy-two percent of AAO s urvivors were alive 5 years after therapy. Conclusions: Acute aortic o cclusion remains a serious vascular surgical emergency with significan t morbidity and mortality, even when recognized promptly and treated a ppropriately. Nevertheless, survivors have a reasonable long-term outc ome. Permanent anticoagulation is suggested in patients with embolic A AO to minimize a high incidence of recurrent arterial embolism.