Drager S B, Riles T S, Imparato A M
Am J Surg. 1979 Aug;138(2):293-5. doi: 10.1016/0002-9610(79)90389-1.
Acute aortic occlusion is most often seen in elderly patients with advanced cardiac disease. The management of these patients has been facilitated by the use of extraanatomic bypass. Over the past 2 years, six patients aged 55 to 87 years presented to our medical center with acute aortic occlusion, three after major operative procedures. One patient had a thrombosed abdominal aortic aneurysm; in the other five patients differentiation between saddle embolus and thrombosis of the distal aorta was impossible. There was one operative death. Four of the other five patients underwent axillobifemoral bypass and one underwent aortofemoral thrombectomy. All survived, and none required amputation. Two of the three patients who underwent preoperative aortography developed transient renal failure postoperatively. Aortography is of little value in diagnosis and is probably contraindicated in acute aortic occlusion. Our recommendation for operative management includes (1) preparation of the patient for possible axillobifemoral bypass, (2) angiography of distal runoff via both femoral arteries, (3) attempt at bilateral aortofemoral embolectomy with Fogarty catheters, and (4) axillobifemoral bypass if embolectomy fails to restore normal pulsatile flow.
急性主动脉闭塞最常见于患有晚期心脏病的老年患者。使用解剖外旁路手术有助于这类患者的治疗。在过去2年中，6例年龄在55至87岁的患者因急性主动脉闭塞前来我院就诊，其中3例是在大手术后出现。1例患者患有腹主动脉瘤血栓形成；在其他5例患者中，无法区分鞍状栓子和远端主动脉血栓形成。有1例手术死亡。其他5例患者中有4例行腋双股旁路手术，1例行主动脉股动脉血栓切除术。所有患者均存活，无一例需要截肢。3例行术前主动脉造影的患者中有2例术后出现短暂性肾衰竭。主动脉造影在诊断中价值不大，在急性主动脉闭塞中可能是禁忌的。我们对手术治疗的建议包括：（1）使患者做好可能行腋双股旁路手术的准备；（2）通过双侧股动脉对远端血流进行血管造影；（3）尝试用Fogarty导管进行双侧主动脉股动脉栓子切除术；（4）如果栓子切除术未能恢复正常搏动血流，则行腋双股旁路手术。
