Leopardi Marco, Maggipinto Annamaria, Bafile Gennaro
Vascular Surgery Unit, San Salvatore Hospital, University of L'Aquila, Via L. Natali 67100, L'Aquila, Italy.
Ann Med Surg (Lond). 2021 Jun 11;67:102506. doi: 10.1016/j.amsu.2021.102506. eCollection 2021 Jul.
Acute limb ischemia after infrarenal aortic repair is a rare complication, which in mainly described to appear in a short time after surgery.The aim of this paper is to describe a case of a 66-year-old woman who presented at out attention with acute right limb ischemia, one year later an aortic repair for acute abdominal aortic aneurysm rupture. In the best of our knowledge there are no cases of sudden graft occlusion after such long time, described in literature.
Patient presented with sudden pain and pallor in the right lower limb and subsequently same symptoms to the left lower limb. One year before she underwent an emergency repair for abdominal aortic aneurysm rupture with an aortobiliac graft. Computed Tomography Angiography (CTA) scan showed a complete occlusion of the infrarenal aorta, including aortoiliac graft, to the common bilateral iliac arteries. On the right side was also found a complete occlusion of the popliteal artery.Emergent embolectomy of the right popliteal artery via the femoral artery was performed.
CTA scan performed on third post-operative day showed the patency of infrarenal aorta and aortic portion of the grafts in presence of floating thrombus, right iliac branch patency and chronic occlusion of left iliac branch. A kinking of both graft iliac branches was evident after this CTA scan. CTA scan at one month demonstrated resolution of the thrombosis of the infrarenal aorta, complete patency of aortic portion of the graft and right iliac branch and chronic obstruction of the left common iliac artery.
Acute limb ischemia caused by sudden graft occlusion one year later an aortic repair for acute abdominal aortic aneurysm rupture is a very rare event. Graft limbs kinking could explain acute thrombosis of the graft.
肾下腹主动脉修复术后急性肢体缺血是一种罕见的并发症，主要描述为在手术后短时间内出现。本文的目的是描述一例66岁女性患者，她在因急性腹主动脉瘤破裂接受主动脉修复一年后，出现急性右下肢缺血并引起我们的关注。据我们所知，文献中未描述过如此长时间后突然出现移植物闭塞的病例。
患者出现右下肢突发疼痛和苍白，随后左下肢也出现同样症状。一年前，她因腹主动脉瘤破裂接受了主动脉双髂动脉移植物紧急修复手术。计算机断层血管造影（CTA）扫描显示肾下腹主动脉完全闭塞，包括主动脉双髂动脉移植物直至双侧髂总动脉。右侧还发现腘动脉完全闭塞。通过股动脉对右腘动脉进行了紧急取栓术。
术后第三天进行的CTA扫描显示，存在漂浮血栓时肾下腹主动脉及移植物的主动脉部分通畅，右髂支通畅，左髂支慢性闭塞。此次CTA扫描后，两个移植物髂支均明显出现扭结。术后一个月的CTA扫描显示肾下腹主动脉血栓溶解，移植物主动脉部分及右髂支完全通畅，左髂总动脉慢性阻塞。
急性腹主动脉瘤破裂修复术后一年，突然出现移植物闭塞导致急性肢体缺血是非常罕见的事件。移植物肢体扭结可能解释移植物的急性血栓形成。
