[Acute occlusions of the aorta].
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.
Favre
J P
JP
Service de chirurgie vasculaire, CHU Hôpital Nord, Saint-Etienne.
Gay
J L
JL
Gournier
J P
JP
Barral
X
X
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D017128:Embolectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation
Les aiguës de l'aorte.