Images in Aortic Disease

Download PDF (430.9 KB)

AORTA, October 2013, Volume 1, Issue 5:255-256
DOI: 10.12945/j.aorta.2013.13-039

Acute Total Occlusion of the Abdominal Aorta in an Elderly Patient with Atrial Fibrillation

Xiaoye He, MD, Yu Hu, MD*

Department of Geriatrics, Affiliated Zhongshan Hospital of Fudan University, Shanghai, China

Abstract

A 76-year-old man without regular anticoagulation therapy for his atrial fibrillation was found to have a complete occlusion of the abdominal aorta and bilateral iliac and femoral arteries, confirmed by multi-slice computed tomography angiography. Prompt diagnosis and immediate intervention are important to minimize complications and avoid fatal outcome whenever arterial occlusion is suspected or diagnosed.

Introduction

A 76-year-old man presented with 5 hours of hypoesthesia of the lower extremities. He had chronic atrial fibrillation along with a past history of stroke and was not anticoagulated. He declined surgical intervention, and expired after supportive medical care and anticoagulation. Multi-slice computed tomography angiography of the patient's lower extremity vessels showed luminal narrowing in abdominal aorta below the left renal artery and the lower segment of abdominal aorta, and bilateral iliac, femoral, and other lower extremity arteries were occluded (Fig. 1).

Figure 1.

The whole image (A), 3-dimensional computed tomography image (B), and cross-sectional computed tomography images (C) of the patient. Arrows refer to the aortic occlusion position.

media/vol1/issue5/images/ata0041300460001.jpg

Acute total occlusion of the abdominal aorta is rare and potentially catastrophic, as indicated in this case. It can be caused by embolus or thrombus, which obstructs distal arterial blood flow. Many factors such as atherosclerosis, dissection, or aneurysm [1] have been associated with aortic mural thrombi, and acute thrombosis may also be related to identifiable hypercoagulable states [24]. The most common source of emboli is the heart, secondary to atrial fibrillation or myocardial infarction. The differentiation between embolus and thrombus can be difficult, but atrial fibrillation is viewed as a reliable discriminator [5].

Acute occlusion of the abdominal aorta is associated with high morbidity and mortality. The causes of death are not only associated with major organ ischemia, but also with severe respiratory failure, fatal arrhythmia, uncontrollable hyperkalemia, and renal failure secondary to myonecrosis [6]. Delay in diagnosis severely impacts prognosis. The clinical picture of acute arterial occlusion includes the classic 6 “P's”: pain, paresthesia, paralysis, pallor, pulselessness, and poikilothermia. Immediate intervention is important to minimize complications and avoid fatal outcome whenever aortic occlusion is suspected or diagnosed. Heparin alone is not effective, and aggressive treatment is essential, with embolectomy, surgical therapy, and, when necessary, amputation.

References

  1.  
    Sheikhzadeh A, Ehlermann P. Atheromatous disease of the thoracic aorta and systemic embolism. Clinical picture and therapeutic challenge. Z Kardiol. 2004;93:10–17. DOI: 10.1007/s00392-004-1030-z
  2.  
    Poirée S, Monnier-Cholley L, Tubiana JM, Arrivé L. Acute abdominal aortic thrombosis in cancer patients. Abdom Imaging. 2004;29:511–513.
  3.  
    Kaushik S, Federle MP, Schur PH, Krishnan M, Silverman SG, Ros PR. Abdominal thrombotic and ischemic manifestations of the antiphospholipid antibody syndrome: CT findings in 42 patients. Radiology. 2001;218:768–771. DOI: 10.1148/radiology.218.3.r01fe43768
  4.  
    Gouin-Thibaut I, Samama MM. Venous thrombosis and cancer. Ann Biol Clin (Paris). 2000;675–682.
  5.  
    Cambria RP, Abbott WM. Acute arterial thrombosis of the lower extremity. Its natural history contrasted with arterial embolism. Arch Surg. 1984;119:784–787. DOI: 10.1001/archsurg.1984.01390190028006
  6.  
    Surowiec SM, Isiklar H, Sreeram S, Weiss VJ, Lumsden AB. Acute occlusion of the abdominal aorta. Am J Surg. 1998;76:193–197. DOI: 10.1016/S0002-9610(98)00129-9

PDF

Download the article PDF (430.9 KB)

Download the full issue PDF (6.83 MB)

Mobile-ready Flipbook

View the full issue as a flipbook (Desktop and Mobile-ready)

Cite this article as: He X, Hu Y. Acute Total Occlusion of the Abdominal Aorta in an Elderly Patient with Atrial Fibrillation. AORTA (Stamford). 2013;1(5):255-256. DOI: 10.12945/j.aorta.2013.13-039

You must be registered and logged in to leave comments.

There have been no comments posted yet

All comments will be screened and reviewed before posting. Statements, opinions, and results of studies published in AORTA Journal are those of the authors and do not reflect the policy or position of The Journal and Science International and the Editorial Board and provides no warranty as to their accuracy or reliability. Material is copyrighted and owned by Science International and cannot be used without expressed permission.