Favre J P, Gay J L, Gournier J P, Barral X
Service de chirurgie vasculaire, CHU Hôpital Nord, Saint-Etienne.
J Chir (Paris). 1995 Jan;132(1):7-12.
Acute occlusion of the aorta is a vascular emergency with high mortality, greater than 30% after revascularization, due to the extent of the ischaemic territory and the haemodynamic consequences. Over a period of 12 years, 34 patients (22 males, 12 females) underwent surgery for acute occlusion of the aorta. Acute bilateral ischaemia was present in 24, unilateral ischaemia in 6 and sub-acute ischaemia in 4. An embolus of cardiac origin was the cause in 13 cases, disease of the aorta itself in 11 cases and hypercoagulability in 10 including 7 due to allergy to heparin. The delay from onset of ischaemia to revascularization was 9 hours (mean). Revascularization was done by simple bifemoral embolectomy in 19 cases, by aortobifemoral bypass in 9 and by extra-anatomic bypass in 6 (3 supra-pubic, 3 axillo-bifemoral). Six patients (18%) died during the post-operative period. Delay to care had been greater than 12 hours in most of these patients. One or more post-operative complications occurred in 18 patients (53 p. 100) including repeated thrombosis, insufficient revascularization, ischaemic neuropathy. Long-term survival at 3 years was 30%. Prognosis might be improved by three elements: reducing the duration of ischaemia by rapid diagnosis and emergency revascularization, better control of metabolic disorders, screening for heparin allergy before thrombotic events occur.
主动脉急性闭塞是一种血管急症，死亡率很高，血管重建术后死亡率超过30%，这是由于缺血区域的范围和血流动力学后果所致。在12年的时间里，34例患者（22例男性，12例女性）接受了主动脉急性闭塞的手术治疗。其中24例为急性双侧缺血，6例为单侧缺血，4例为亚急性缺血。13例病因是心脏源性栓子，11例是主动脉本身疾病，10例是高凝状态，其中7例是对肝素过敏。从缺血发作到血管重建的延迟时间平均为9小时。19例通过单纯双股动脉取栓术进行血管重建，9例通过主动脉双股动脉旁路移植术，6例通过解剖外旁路移植术（3例耻骨上旁路，3例腋双股旁路）。6例患者（18%）在术后期间死亡。这些患者中的大多数延误治疗时间超过12小时。18例患者（53%）发生了一种或多种术后并发症，包括反复血栓形成、血管重建不足、缺血性神经病变。3年的长期生存率为30%。通过三个因素可能改善预后：通过快速诊断和紧急血管重建减少缺血持续时间、更好地控制代谢紊乱、在血栓形成事件发生前筛查肝素过敏。
