From the Division of Vascular Surgery, New York University/Winthrop Hospital, Mineola, NY.
Cardiol Rev. 2021;29(2):57-61. doi: 10.1097/CRD.0000000000000313.
Acute occlusion of the abdominal aorta is a catastrophic occurrence that results in high risk of limb loss and death. The etiology has historically been either acute embolism obstructing the aortic bifurcation in 8% to 75% of patients, or thrombosis of existing aorta-iliac occlusive disease in 35% to 84% of patients. Other etiologies include thrombosis of either a previously placed endograft or aortic graft or acute dissection. The most common symptoms are severe pain in almost 100% of patients or lower extremity paralysis/paresis in up to 80% of patients. Evaluation in the past was by angiography, but presently, computed tomography angiography is the preferred imaging study. Treatment is dependent on the etiology and includes embolectomy, aorta femoral bypass, axillary femoral bypass, and endovascular techniques. The aim of intervention is to restore flow in the shortest time period. Mortality rates vary widely from 17% to 52%, amputation occurs in up to 30% of patients. Paraplegia can occur in 40% of patients, renal insufficiency in 40% to 70%, and visceral ischemia in 6% to 14%. Both mortality and morbidity are affected by the duration of ischemia and the local and systemic complications of reperfusion injury. Complications of acute aortic occlusion can be reduced by a more prompt diagnosis, rapid intervention, and a more rapid and complete reestablishment of perfusion.
急性腹主动脉闭塞是一种灾难性事件，可导致高截肢和死亡风险。其病因历史上要么是急性栓塞阻塞主动脉分叉，占 8%至 75%的患者；要么是主动脉-髂动脉闭塞性疾病的血栓形成，占 35%至 84%的患者。其他病因包括先前放置的血管内移植物或主动脉移植物的血栓形成或急性夹层。最常见的症状是几乎 100%的患者出现严重疼痛或高达 80%的患者出现下肢瘫痪/无力。过去的评估方法是血管造影，但目前，计算机断层血管造影是首选的影像学研究。治疗取决于病因，包括血栓切除术、股动脉旁路移植术、腋股旁路移植术和血管内技术。干预的目的是在最短的时间内恢复血流。死亡率从 17%到 52%不等，高达 30%的患者发生截肢。截瘫可发生在 40%的患者中，肾功能不全发生在 40%至 70%，内脏缺血发生在 6%至 14%。缺血持续时间以及再灌注损伤的局部和全身并发症都会影响死亡率和发病率。更及时的诊断、快速干预以及更快和更完全的再灌注可以减少急性主动脉闭塞的并发症。
