A modern series of acute aortic occlusion

Objective Acute aortic occlusion (AAO) is a rare condition associated with substantial morbidity and mortality. The most recent large series was published over 15 years ago and included patients from the 1980s. Previous studies reported up to 50% of AAOs are caused by embolization, with a mortality rate approaching 50%. We reviewed our recent experience with AAOs to identify current etiologies and outcomes in a contemporary series of patients with AAOs. Methods Current Procedural Terminology codes and data from a prospectively maintained vascular surgical database were used to identify patients with acute occlusion of the native aorta between 2005 and July 2013. AAOs secondary to trauma, dissection, or graft occlusion were excluded. Results We identified 29 patients with AAOs treated at our institution. Twenty-three patients were transferred from referring hospitals with a mean transfer time of 3.9 hours (range, 0.5-7.5 hours). Twenty-two presented with occlusion below the renal arteries and seven with occlusion extending above the renal arteries. Resting motor/sensory lower extremity deficits were noted in 17 patients. Eight patients presented with complete paraplegia. Etiology was felt to be aortoiliac thrombosis in 22 cases, embolic occlusion in 2, and indeterminate in 5. Surgical revascularization was performed in 26 cases (extra-anatomic bypass in 18, thromboembolectomy in 5, and aortobifemoral bypass in 3 patients. Three patients had no intervention. Acute renal failure developed in 15 patients and rhabomyolysis in 10 patients. Fasciotomy was performed in 19 extremities. Nine extremities were amputated in six patients. Overall mortality was 34% with a 30-day mortality of 24% and a postprocedure mortality of 15%. Conclusions AAO is an infrequent but devastating event. The dominant etiology of AAOs is now thrombotic occlusion. Despite advances in vascular surgery and critical care over the past 2 decades, associated morbidity and mortality remain substantial with high rates of limb loss, acute renal failure, rhabdomyolysis, and death. Mortality may be improved with expeditious extra-anatomic bypass.