TCTAP C-223 Successful Endovascular Therapy for Acute Limb Ischemia Due to Kinking of Bifurcated Graft for Abdominal Aortic Aneurysm

Thrombosis of an abdominal aortic aneurysm is a rare devastating complication with an estimated mortality rate of 50%. Simultaneous acute pain, pallor and coldness of the lower limbs, mottling from the level of iliac crests or umbilicus, paraplegia and absence of femoral pulses are all manifestations of a sudden and acute interruption of blood flow through the aneurysmatic aorta. We report a case of an occlusion of an abdominal aortic aneurysm during hospitalization which was not manifested with symptoms of limb ischemia. In this case we feature the rare and unusually “silent” presentation of the event.

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Acute Thromboembolism from Trauma in a Patient with Abdominal Aortic Aneurysm

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.4.52137 ◽

2021 ◽

Vol 5 (3) ◽

pp. 357-359

Author(s):

Solomon Sebt ◽

Chris Kim ◽

Wirachin Hoonpongsimanont ◽

Eric Leroux

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Rare Complication ◽

Limb Ischemia ◽

Point Of Care Ultrasound ◽

Acute Limb Ischemia ◽

Thromboembolic Events ◽

Acute Thrombosis ◽

Abdominal Aortic ◽

History Of

Case Presentation: A 64-year-old man with a history of a 5.5-centimeter (cm) abdominal aortic aneurysm (AAA) presented to the emergency department (ED) complaining of severe back pain after climbing over a fence and falling a distance of eight feet. Prior to arrival, the prehospital paramedics reported that the patient did not have palpable pulses in either lower extremity. The initial physical examination in the ED was significant for absent dorsalis pedis pulses bilaterally as well as absent posterior tibialis pulses bilaterally and cold, insensate lower extremities. Point-of-care ultrasound identified an approximate 7-cm infrarenal AAA with a mural thrombus present. After receiving several computed tomography (CT) studies including CT head without contrast and CT angiography of the chest, abdomen and pelvis, the patient was diagnosed with acute thrombosis of AAA and associated thromboembolic occlusion of both his right and left distal iliac vessels causing bilateral acute limb ischemia. He immediately received unfractionated heparin and was admitted to the hospital for embolectomy and intra-arterial tissue plasminogen activator. Discussion: Acute thrombosis of AAA and subsequent thromboembolic events are a rare but significant complication that can occur in patients with a history of AAA. Thromboembolic events may occur spontaneously or in the setting of blunt abdominal trauma. Common presenting signs and symptoms include distal limb ischemia and absent femoral pulses. Timely management and recognition of this rare complication is vital as this condition can ultimately result in limb loss or death if not treated in a timely manner. Heparinization after confirmation of non-ruptured AAA as well as vascular surgery, and therapeutic and vascular interventional radiology consultations are key steps that should be taken to decrease patient morbidity and mortality.

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Management of acute limb ischemia after glue embolization of endoleak following endovascular abdominal aortic aneurysm repair

Journal of Vascular Surgery Cases ◽

10.1016/j.jvsc.2015.07.004 ◽

2015 ◽

Vol 1 (3) ◽

pp. 217-220

Author(s):

Maged M. Metias ◽

Ahmed Kayssi ◽

Thomas F. Lindsay ◽

Dheeraj K. Rajan

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Limb Ischemia ◽

Abdominal Aortic Aneurysm Repair ◽

Acute Limb Ischemia ◽

Abdominal Aortic ◽

Glue Embolization ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

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An Unusual Case of Acute Thrombosis of Abdominal Aortic Aneurysm without Acute Limb Ischemia

Aorta ◽

10.1055/s-0038-1636991 ◽

2018 ◽

Vol 06 (01) ◽

pp. 031-033

Author(s):

Spyridon Vasdekis ◽

Sotiria Mastoraki ◽

Andreas Lazaris ◽

Konstantinos Moulakakis

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Unusual Case ◽

Limb Ischemia ◽

Preoperative Anxiety ◽

Morbidity And Mortality ◽

High Morbidity ◽

Acute Limb Ischemia ◽

Acute Thrombosis ◽

Abdominal Aortic

AbstractAcute thrombosis of an abdominal aortic aneurysm (AAA) is a rare and often devastating complication with high morbidity and mortality. In some cases, however, it may be associated with a silent course without signs of acute limb ischemia. The aim of this report is to describe an unusual case of acute thrombosis of AAA without signs of acute limb ischemia. Preoperative anxiety, stress, and phobia for surgery may be factors predisposing to acute thrombosis of an AAA.

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Acute Limb Ischemia After Abdominal Aortic Aneurysm Repair

Aortic Aneurysms ◽

10.1007/978-1-60327-204-9_22 ◽

2009 ◽

pp. 315-324

Author(s):

Paul J. Riesenman ◽

William A. Marston

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Limb Ischemia ◽

Abdominal Aortic Aneurysm Repair ◽

Acute Limb Ischemia ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

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Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10010162 ◽

2021 ◽

Vol 10 (1) ◽

pp. 162

Author(s):

Christian-Alexander Behrendt ◽

Thea Kreutzburg ◽

Jenny Kuchenbecker ◽

Giuseppe Panuccio ◽

Mark Dankhoff ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Propensity Score ◽

Acute Limb Ischemia ◽

Insurance Claims ◽

Long Term Outcomes ◽

Term Survival ◽

Abdominal Aortic ◽

Significant Difference

Objective: Previous studies have showed a potential disadvantage of female patients who underwent abdominal aortic aneurysm (AAA) repair. The current study aims to determine sex-specific perioperative and long-term outcomes using propensity score matched unselected nationwide health insurance claims data. Methods: Insurance claims from a large German fund were used, covering around 8% of the insured German population. Patients who underwent endovascular aortic repair (EVAR) for intact AAA from 1 January 2011 to 30 April 2017 were included in the cohort. A 1:2 female to male propensity score matching was applied to adjust for confounding variables. Perioperative and long-term outcomes after 5 years were determined using matching and regression methods. Results: Among a total of 3736 patients (19.3% females, mean 75 years) undergoing EVAR for intact AAA, we identified 1863 matched patients. Before matching, females were more likely to be previously diagnosed with hypothyroidism, electrolyte disorders, rheumatoid disorders, and depression, while males were more often diabetics. In the matched sample, 23.4% of the females and 25.8% of the males died during a median follow-up of 776 and 792 days, respectively. Perioperatively, females were more likely to exhibit acute limb ischemia (5.3% vs. 3.2%, p = 0.031) and major bleeding (22.0% vs. 15.9%, p = 0.001) before they were discharged to rehabilitation (5.5% vs. 1.5%, p < 0.001) when compared to males. No statistically significant difference in perioperative (odds ratio 1.12, 95% CI 0.54–2.16) or long-term mortality (hazard ratio 0.91, 95% CI 0.76–1.08) was observed between sexes. This was also true regarding aortic reintervention rates after 1 year (2.0% vs. 2.9%) and 5 years (10.9% vs. 8.1%). Conclusion: The current retrospective matched analysis of insurance claims revealed high early access-related morbidity in females when compared to their male counterparts. Short-term or long-term survival and reintervention outcomes were similar between sexes.

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