Babu S C, Shah P M, Nitahara J
Department of Surgery, New York Medical College, Westchester Medical Center, Valhalla, USA.
J Vasc Surg. 1995 Apr;21(4):567-72; discussion 573-5. doi: 10.1016/s0741-5214(95)70188-5.
The purpose of this study was to report our experience in the management of acute aortic occlusion and to analyze factors that influenced the outcome.
This was a retrospective analysis of 48 patients with acute aortic occlusion treated over a 19-year period. Presentation included limb ischemia in 34, acute abdomen in four, spinal cord compression-like symptoms in eight, and sudden onset of hypertension in two patients. Thrombosis was the cause of acute aortic occlusion in 44, and embolus in four patients. Acute thrombosis was associated with underlying atherosclerotic occlusive disease in 36 patients. In these, thrombosis was due to low-flow state caused by cardiac dysfunction or severe volume depletion. Thrombosed aneurysms caused aortic occlusion in two patients. Hypercoagulable state caused thrombosis of relatively normal aorta in six patients. Angiography in 39 patients revealed occlusion to be juxtarenal or infrarenal in 37 and suprarenal in two. Left ventricular function (LVF) was assessed in 42 patients. Circulation was restored in 45 (aortofemoral bypass in 22, axillofemoral bypass in 12, and thromboembolectomy in 11). This was not feasible in three patients. Additional surgical procedures were required in 29 patients (64%).
The overall mortality rate was 52% (25 of 48). Of the 20 patients with severely compromised LVF, 17 died (85%). In contrast, only five (23%) deaths occurred among 22 with good LVF. Among 29 patients who required additional operations, 18 died (62%). All four patients with embolic occlusion survived. Patients with normal LVF but hypercoagulable state had dismal outcome--only one of the six survived.
Acute aortic occlusion is infrequent. Presentation may be varied, thus delaying diagnosis. Poor LVF, thrombosis of arteries below the inguinal ligament or of visceral arteries, and "hypercoagulable state" portend ominous prognosis.
本研究旨在报告我们在急性主动脉闭塞治疗方面的经验，并分析影响治疗结果的因素。
这是一项对48例在19年期间接受治疗的急性主动脉闭塞患者的回顾性分析。临床表现包括34例肢体缺血、4例急腹症、8例脊髓压迫样症状以及2例高血压突然发作。44例急性主动脉闭塞的病因是血栓形成，4例是栓子。36例急性血栓形成与潜在的动脉粥样硬化闭塞性疾病相关。在这些病例中，血栓形成是由心脏功能障碍或严重血容量不足导致的低血流状态引起的。2例患者的血栓性动脉瘤导致主动脉闭塞。高凝状态导致6例相对正常的主动脉发生血栓形成。39例患者的血管造影显示，37例闭塞位于肾旁或肾下，2例位于肾上。对42例患者评估了左心室功能（LVF）。45例患者恢复了循环（22例行主动脉股动脉旁路移植术，12例行腋股动脉旁路移植术，11例行血栓栓子切除术）。有3例患者无法进行上述治疗。29例患者（64%）需要进行额外的外科手术。
总体死亡率为52%（48例中的25例）。20例左心室功能严重受损的患者中，17例死亡（85%）。相比之下，22例左心室功能良好的患者中仅5例（23%）死亡。29例需要进行额外手术的患者中有18例死亡（62%）。所有4例栓子闭塞患者均存活。左心室功能正常但处于高凝状态的患者预后不佳——6例中仅1例存活。
急性主动脉闭塞并不常见。临床表现可能多种多样，从而延误诊断。左心室功能差、腹股沟韧带以下动脉或内脏动脉血栓形成以及“高凝状态”预示预后不良。
