Webb K H, Jacocks M A
Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City 73190.
Am J Surg. 1988 Mar;155(3):405-7. doi: 10.1016/s0002-9610(88)80100-4.
Acute aortic occlusion is a rare and emergent vascular event. Patients who present with this disorder have a classical history and physical examination consistent with occlusion of the distal aorta and resultant ischemia to the distal tissues. Time is of the essence in dealing with these patients. Aortography proved to be important in determining renal artery involvement in our patients. Based on this finding, we suggest that preoperative arteriograms be obtained. The method of treating these patients after arteriography should be to move quickly to the operating room. Patients with renal artery occlusion must be seriously considered for primary revascularization with either aortofemoral or aortoiliac reconstruction and thrombectomy or bypass of the occluded renal artery. If no renal artery involvement is revealed on arteriography, the initial operation should include an attempt to reestablish inflow by retrograde femoral thromboembolectomy under local anesthesia. If that fails, a decision must be made based on the patient's clinical status, whether a major vascular procedure would be tolerated. If so, primary revascularization or transabdominal thrombectomy should be attempted. If the patient is deemed unable to tolerate a major vascular procedure, then axillobifemoral bypass under local anesthesia should be performed. Postoperatively, the patient should be aggressively managed to prevent pulmonary and renal complications. Even with aggressive surgical management and postoperative care, these patients have an uncertain postoperative course. It is of primary importance that physicians realize that time is a critical factor and these patients must be referred to the appropriate care center promptly. Only by ensuring prompt surgical management can a mortality rate of less than 50 percent be expected.
急性主动脉闭塞是一种罕见的急症血管事件。出现这种病症的患者具有与远端主动脉闭塞及由此导致的远端组织缺血相一致的典型病史和体格检查结果。处理这些患者时时间至关重要。在我们的患者中，主动脉造影被证明在确定肾动脉受累情况方面很重要。基于这一发现，我们建议术前进行动脉造影。动脉造影后治疗这些患者的方法应是迅速进入手术室。对于肾动脉闭塞的患者，必须认真考虑采用主动脉股动脉或主动脉髂动脉重建及血栓切除术或对闭塞的肾动脉进行旁路移植术进行一期血运重建。如果动脉造影未显示肾动脉受累，初始手术应包括尝试在局部麻醉下通过逆行股动脉取栓术重建血流。如果失败，必须根据患者的临床状况决定是否能耐受大型血管手术。如果可以，则应尝试一期血运重建或经腹血栓切除术。如果患者被认为无法耐受大型血管手术，则应在局部麻醉下进行腋双股旁路移植术。术后，应对患者进行积极处理以预防肺部和肾脏并发症。即使采用积极的手术治疗和术后护理，这些患者的术后病程仍不确定。医生必须认识到时间是关键因素，这些患者必须迅速转诊至合适的护理中心，这一点至关重要。只有确保及时的手术治疗，才有望使死亡率低于50%。
