Contemporary Management of Acute Aortic Occlusion Has Evolved but Outcomes Have Not Significantly Improved

Robinson, William P.; Patel, Rupal K.; Columbo, Jesse A.; Flahive, Julie; Aiello, Francesco; Baril, Donald T.; Schanzer, Andres; Messina, Louis M.

doi:10.1016/j.avsg.2015.12.021

Cited by 28 publications

(23 citation statements)

References 16 publications

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“…255 Most publications consist of relatively small case series, and in a recent paper the authors concluded that outcome had not improved over time. 256…”

Section: Aetiology and Diagnosismentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Björck

Earnshaw

Acosta

et al. 2020

European Journal of Vascular and Endovascular Surgery

312

222

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“…255 Most publications consist of relatively small case series, and in a recent paper the authors concluded that outcome had not improved over time. 256…”

Section: Aetiology and Diagnosismentioning

confidence: 99%

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

Björck

Earnshaw

Acosta

et al. 2020

European Journal of Vascular and Endovascular Surgery

312

222

View full text Add to dashboard Cite

“…Several studies have highlighted the importance of the early detection of AAO in order to reduce morbidity and mortality for these patients, as both tissue damage and reperfusion injury correlate with the duration of ischaemia. 3,6,10 One of the limitations of this study is that detailed data on the time from AAO to revascularisation are lacking. Only cases where the patients received surgical treatment were included and data on comorbidities were not complete in all cases.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports have provided both safety and efficacy results for thrombolytic therapy. 10,27 Thrombolysis seems to be particularly efficient in occluded graft/stent/stent grafts and represents a good alternative if the ischaemic state permits a more gradual reperfusion. 29 This may also be the preferred therapy in patients with hypercoagulable states, because this subset of patients responds poorly to surgical intervention, despite normal arteries and good cardiac function.…”

Section: Discussionmentioning

confidence: 99%

“…6e8 Two contemporary case series report that mortality and morbidity continue to be high and unchanged in this vulnerable patient group, despite advances in diagnostic and surgical techniques in the last few decades. 9,10 The most common aetiologies causing AAOs are large saddle embolus to the aortic bifurcation or native artery thrombosis of an atherosclerotic aorta. Previous surgical reconstructions on the aorta may also occlude and cause AAO.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Temporal Trends and Management of Acute Aortic Occlusion: A 21 Year Experience

Grip

Wanhainen

Björck

2019

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Acute aortic occlusion is a rare, serious, and yet poorly investigated event. It can be caused by different aetiologies and be treated in many different ways. This investigation includes far more patients than all previous reports and can therefore report on time trends including long term survival with reporting of similar results for patient subgroups. Objectives: The aim was to study patients with acute aortic occlusion (AAO), a rare and life threatening event, in a population based cohort and the outcome of surgical treatment. Methods: The Swedish nationwide vascular database (Swedvasc) was used to identify cases, and the population registry to study long term survival. Variables associated with outcome were tested with the chi-square test and analysis of variance. Results: During the 21 year study period (1994e2014), 693 cases of surgical treatment for AAO were included, with a yearly incidence of 3.6 per million inhabitants. Mean AE SD age was 69.9 AE 11.2 years, 352 patients (50.8%) were women, and mean AE SD length of follow up was 5.2 AE 5.5 years. Most patients presented with bilateral acute limb ischaemia (596 patients, 86.0%). The aetiology of AAO was native artery thrombosis in 458 patients (66.1%), saddle embolus in 152 (21.9%), and occluded graft/stent/stent grafts in 83 (12.0%). The proportion of occluded grafts/stent/stent grafts increased during the study period (n ¼ 14 [6.7%] in 1994e 2000 vs. n ¼ 45 [17.4%] in 2008e2014; p < .001) with a simultaneous reduction of arterial thrombosis (n ¼ 149 [71.6%] in 1994e2000 vs. n ¼ 158 [61.2%] in 2008e2014; p <. 001). Major amputation above the ankle was performed in 39 patients (8.5%), and 140 patients died within 30 days of surgery (20.2%). Thirty day mortality rate was lower after occluded grafts/stents/stent grafts (eight patients [9.6%]) and higher after saddle embolus (47 patients [30.9%]); p < .001). There was a reduction in overall 30 day mortality over time (n ¼ 53 [25.5%] in 1994e2000 vs. n ¼ 40 [15.5%] in 2008e2014; p ¼ .007). Long term survival revealed significant differences between the subgroups, although the difference occurred early after the event (p < .001). Conclusions: Mortality after surgical treatment of AAO is improving over time, yet a significant mortality rate was observed throughout the study period. The proportion of AAO secondary to occluded grafts/stents/stent grafts increased over time.

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“…Critical leg ischemia due to a thrombosed AAA is extremely rare with <50 reported cases ( 1 ). A prompt diagnosis and immediate revascularization by surgical or endovascular intervention, is mandatory for avoiding catastrophic outcomes ( 2 ).…”

mentioning

confidence: 99%