Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

The Role of Extra-Anatomic Bypass in the Surgical Treatment of Acute Abdominal Aortic Occlusion

  • Ilhan, Gokhan (Department of Cardiovascular Surgery, Recep Tayyip Erdogan University Faculty of Medicine) ;
  • Bozok, Sahin (Department of Cardiovascular Surgery, Recep Tayyip Erdogan University Faculty of Medicine) ;
  • Ergene, Saban (Department of Cardiovascular Surgery, Recep Tayyip Erdogan University Faculty of Medicine) ;
  • Karakisi, Sedat Ozan (Department of Cardiovascular Surgery, Recep Tayyip Erdogan University Faculty of Medicine) ;
  • Tufekci, Nebiye (Department of Cardiovascular Surgery, Recep Tayyip Erdogan University Faculty of Medicine) ;
  • Kazdal, Hizir (Department of Anesthesia and Reanimation, Recep Tayyip Erdogan University Faculty of Medicine) ;
  • Ogullar, Sabri (Department of Radiology, Recep Tayyip Erdogan University Faculty of Medicine) ;
  • Kucuker, Seref Alp (Department of Cardiovascular Surgery, Recep Tayyip Erdogan University Faculty of Medicine)
  • Received : 2015.01.19
  • Accepted : 2015.05.29
  • Published : 2015.06.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Aortic occlusion is rare catastophic pathology with high rates of mortality and severe morbidity. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extra-anatomic bypass procedures. Methods: Eighteen patients who had undergone extra-anatomic bypass interventions in the cardiovascular surgery department of our tertiary care center between July 2009 and May 2013 were retrospectively evaluated. All patients were preoperatively assessed with angiograms (conventional, computed tomography, or magnetic resonance angiography) and Doppler ultrasonography. Operations consisted of bilateral femoral thromboembolectomy, axillo-bifemoral extra-anatomic bypass and femoropopliteal bypass and were performed on an emergency basis. Results: In all patients during early postoperative period successful revascularization outcomes were obtained; however, one of these operated patients died on the 10th postoperative due to multiorgan failure. The patients were followed up for a mean duration of $21.2{\pm}9.4$ months (range, 6 to 36 months). Amputation was not warranted for any patient during postoperative follow-up.. Conclusion: To conclude, acute aortic occlusion is a rare but devastating event and is linked with substantial morbidity and mortality in spite of the recent advances in critical care and vascular surgery. Our results have shown that these hazardous outcomes may be minimized and better rates of graft patency may be achieved with extra-anatomic bypass techniques tailored according to the patient.

Keywords

References

  1. Dossa CD, Shepard AD, Reddy DJ, et al. Acute aortic occlusion: a 40-year experience. Arch Surg 1994;129:603-7. https://doi.org/10.1001/archsurg.1994.01420300041006
  2. Coley C, Lee KR, Steiner M, Thompson CS. Complete embolization of a left atrial myxoma resulting in acute lower extremity ischemia. Tex Heart Inst J 2005;32:238-40.
  3. Crawford JD, Perrone KH, Wong VW, et al. A modern series of acute aortic occlusion. J Vasc Surg 2014;59:1044-50. https://doi.org/10.1016/j.jvs.2013.10.080
  4. Tshomba Y, Melissano G, Apruzzi L, Baccellieri D, Negri G, Chiesa R. Open repair for aortic occlusive disease: indication, techniques, results, tips and tricks. J Cardiovasc Surg (Torino) 2014;55(2 Suppl 1):57-68.
  5. Sen I, Stephen E, Agarwal S. Clinical profile of aortoiliac occlusive disease and outcomes of aortobifemoral bypass in India. J Vasc Surg 2013;57(2 Suppl):20S-5S. https://doi.org/10.1016/S0741-5214(13)00822-7
  6. Babu SC, Shah PM, Nitahara J. Acute aortic occlusion: factors that influence outcome. J Vasc Surg 1995;21:567-72. https://doi.org/10.1016/S0741-5214(95)70188-5
  7. Akay S, Elcin G, Erkan N. Aortic occlusion: five case reports. Turk Gogus Kalp Dama 2012;20:921-5. https://doi.org/10.5606/tgkdc.dergisi.2012.181
  8. Witz M, Lehmann J, Shnaker A, Korzets Z. Acute occlusion of the abdominal aorta associated with lower limb paralysis. Isr Med Assoc J 2007;9:115-6.
  9. Danto LA, Fry WJ, Kraft RO. Acute aortic thrombosis. Arch Surg 1972;104:569-72. https://doi.org/10.1001/archsurg.1972.04180040183031
  10. Langsfeld M, Nepute J, Hershey FB, et al. The use of deep duplex scanning to predict hemodynamically significant aortoiliac stenoses. J Vasc Surg 1988;7:395-9. https://doi.org/10.1016/0741-5214(88)90434-X
  11. Richardson R, Applebaum H, Touran T, et al. Effective thrombolytic therapy of aortic thrombosis in the small premature infant. J Pediatr Surg 1988;23:1198-200. https://doi.org/10.1016/S0022-3468(88)80343-9
  12. Tetik O, Yetkin U, Yurekli I, et al. Surgical management of chronic total occlusion of the abdominal aorta. Turk Gogus Kalp Dama 2011;19:344-9. https://doi.org/10.5606/tgkdc.dergisi.2011.043

Cited by

  1. Risk factors for perioperative mortality after revascularization for acute aortic occlusion vol.68, pp.6, 2015, https://doi.org/10.1016/j.jvs.2018.04.037
  2. Predictors of in-hospital mortality and complications in acute aortic occlusion: a comparative analysis of patients with embolism and in-situ thrombosis vol.62, pp.2, 2015, https://doi.org/10.23736/s0021-9509.20.11247-3