Acute Occlusion of an Abdominal Aortic Aneurysm

Abstract

Acute thrombosis of an abdominal aortic aneurysm (AAA) is a surgical emergency. Only 44 cases have been reported in the literature. The mechanism of the thrombosis has not been delineated. The proposed etiologies include propagation of thrombus from distal artery occlusion, cardiac thromboembolism, and dislodgment of a mural thrombus. Patients often present bilateral lower extremity ischemia, mimicking a saddle embolism. Systemic heparinization immediately after diagnosis and prompt surgical revascularization can reduce the mortality rate. The authors present a patient with sudden thrombosis of an AAA who was successfully treated with an axillobifemoral bypass graft. All published cases of thrombosed AAAs are analyzed.

Acute Bilateral Lower Extremity Paralysis Secondary to Acute Thrombosis of an Infrarenal Abdominal Aortic Aneurysm

“…The initial response to sudden occlusion of an artery is distal spasm in the main channels and collaterals, which is thought to prevent further thrombosis distal to the occlusion [7,9]. The motor deficit in the lower extremities can be explained in part by anterior spinal cord syndrome secondary to acute occlusion of lumbar arteries [9,11,12]. The motor deficit can also theoretically be attributed to sudden acute ischemia to the lower extremity muscles, ultimately leading to neuronal and muscle ischemia.…”

“…Therefore, we postulate that the paralysis was multifactorial in nature, from both an anterior spinal cord syndrome as well as prolonged skeletal muscle ischemia. Although the diagnosis of a thrombosed aorta by clinical signs and symptoms is not difficult, the clinician must differentiate thrombosed AAA from a saddle embolus [11]. This is paramount because the therapeutic intervention for a saddle embolus is a transfemoral embolectomy, whereas an abdominal aortic occlusion requires revascularization [10][11][12].…”

“…Although the diagnosis of a thrombosed aorta by clinical signs and symptoms is not difficult, the clinician must differentiate thrombosed AAA from a saddle embolus [11]. This is paramount because the therapeutic intervention for a saddle embolus is a transfemoral embolectomy, whereas an abdominal aortic occlusion requires revascularization [10][11][12]. To prevent further clot propagation, it is vital to initiate systemic heparinization after the diagnosis has been established in either situation [1, 3, 4, 6-8, 10, 11].…”

“…To prevent further clot propagation, it is vital to initiate systemic heparinization after the diagnosis has been established in either situation [1, 3, 4, 6-8, 10, 11]. Emergent surgical repair is mandatory and usually requires thombectomy and replacement of the aneurysm with graft; however, if this is not feasible, an axillobifemoral bypass should be performed [11,13].…”

Chronic Thrombosed Abdominal Aortic Aneurysms: A Report on Three Consecutive Cases and Literature Review

“…The spontaneous thrombosis of aortic aneurysm is rare 1,5. Acute thrombosis often presents with limb ischemia or neurological deficits and carries a mortality rate up to 50%, as reviewed by Hirose et al2,6 There are only 51 cases of acute thrombosis of AAA reported in the literature 1–13…”