Cargando…

Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management

Primary aortic occlusion (PAO) is defined as acute occlusion in the absence of aortic atherosclerosis or aneurysm. PAO is a rare disease with acute onset and can determine massive parenchymal ischemia and distal arterial embolization. The aim of our study was to focus on the assessment of clinical c...

Descripción completa

Detalles Bibliográficos
Autores principales: Lassandro, Giulia, Tamburrini, Stefania, Liguori, Carlo, Picchi, Stefano Giusto, Pezzullo, Filomena, Ferrandino, Giovanni, Spinetti, Fabio, Vigliotti, Gennaro, Marano, Ines, Scaglione, Mariano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10001136/
https://www.ncbi.nlm.nih.gov/pubmed/36900878
http://dx.doi.org/10.3390/ijerph20053868
_version_ 1784904059718729728
author Lassandro, Giulia
Tamburrini, Stefania
Liguori, Carlo
Picchi, Stefano Giusto
Pezzullo, Filomena
Ferrandino, Giovanni
Spinetti, Fabio
Vigliotti, Gennaro
Marano, Ines
Scaglione, Mariano
author_facet Lassandro, Giulia
Tamburrini, Stefania
Liguori, Carlo
Picchi, Stefano Giusto
Pezzullo, Filomena
Ferrandino, Giovanni
Spinetti, Fabio
Vigliotti, Gennaro
Marano, Ines
Scaglione, Mariano
author_sort Lassandro, Giulia
collection PubMed
description Primary aortic occlusion (PAO) is defined as acute occlusion in the absence of aortic atherosclerosis or aneurysm. PAO is a rare disease with acute onset and can determine massive parenchymal ischemia and distal arterial embolization. The aim of our study was to focus on the assessment of clinical characteristic, CT signs, medical and surgical treatment, complication rates and the overall survival of PAO. Materials and Methods: We retrospectively analyzed the data of all patients with acute lower limb ischemia and a final surgical or discharge diagnosis of PAO who underwent aortic CT angiography in ER settings in our hospital from January 2019 to November 2022. Results: A total of 11 patients (8 males/3 females; male/female ratio, 2.66:1, age range 49 to 79 years-old, mean age 65.27 y/o) with acute onset of lower limb impotence or ischemia were diagnosed with PAO. The etiology was thrombosis in all patients. The aortic occlusion was always located in the abdominal aorta and extended bilaterally through the common iliac arteries. The upper limit of the thrombosis was detected in the aortic subrenal tract in 81.8% of the cases, and in the infrarenal tract in 18.2%. A total of 81.8% of the patients were referred to the ER for symptoms related to lower limb: bilateral acute pain, hypothermia and sudden onset of functional impotence. Two patients (18.2%) died before undergoing surgery for multi-organ failure determined by the severe acute ischemia. The other patients (81.8%) underwent surgical treatment that included aortoiliac embolectomy (54.5%), aortoiliac embolectomy + aorto-femoral bypass (18.2%) and aortoiliac embolectomy and right lower limb amputation (9.1%). The overall mortality was 36.4% while the estimated survival at 1 year was 63.6%. Conclusions: PAO is a rare entity with high morbidity and mortality rates if not recognized and treated promptly. Acute onset of lower limb impotence is the most common clinical presentation of PAO. Aortic CT angiography is the first-choice imaging technique for the early diagnosis of this disease and for the surgical treatment, planning and assessment of any complications. Combined with surgical treatment, anticoagulation is considered the first-line medical therapy at the time of diagnosis, during surgical treatment and after at discharge.
format Online
Article
Text
id pubmed-10001136
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-100011362023-03-11 Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management Lassandro, Giulia Tamburrini, Stefania Liguori, Carlo Picchi, Stefano Giusto Pezzullo, Filomena Ferrandino, Giovanni Spinetti, Fabio Vigliotti, Gennaro Marano, Ines Scaglione, Mariano Int J Environ Res Public Health Article Primary aortic occlusion (PAO) is defined as acute occlusion in the absence of aortic atherosclerosis or aneurysm. PAO is a rare disease with acute onset and can determine massive parenchymal ischemia and distal arterial embolization. The aim of our study was to focus on the assessment of clinical characteristic, CT signs, medical and surgical treatment, complication rates and the overall survival of PAO. Materials and Methods: We retrospectively analyzed the data of all patients with acute lower limb ischemia and a final surgical or discharge diagnosis of PAO who underwent aortic CT angiography in ER settings in our hospital from January 2019 to November 2022. Results: A total of 11 patients (8 males/3 females; male/female ratio, 2.66:1, age range 49 to 79 years-old, mean age 65.27 y/o) with acute onset of lower limb impotence or ischemia were diagnosed with PAO. The etiology was thrombosis in all patients. The aortic occlusion was always located in the abdominal aorta and extended bilaterally through the common iliac arteries. The upper limit of the thrombosis was detected in the aortic subrenal tract in 81.8% of the cases, and in the infrarenal tract in 18.2%. A total of 81.8% of the patients were referred to the ER for symptoms related to lower limb: bilateral acute pain, hypothermia and sudden onset of functional impotence. Two patients (18.2%) died before undergoing surgery for multi-organ failure determined by the severe acute ischemia. The other patients (81.8%) underwent surgical treatment that included aortoiliac embolectomy (54.5%), aortoiliac embolectomy + aorto-femoral bypass (18.2%) and aortoiliac embolectomy and right lower limb amputation (9.1%). The overall mortality was 36.4% while the estimated survival at 1 year was 63.6%. Conclusions: PAO is a rare entity with high morbidity and mortality rates if not recognized and treated promptly. Acute onset of lower limb impotence is the most common clinical presentation of PAO. Aortic CT angiography is the first-choice imaging technique for the early diagnosis of this disease and for the surgical treatment, planning and assessment of any complications. Combined with surgical treatment, anticoagulation is considered the first-line medical therapy at the time of diagnosis, during surgical treatment and after at discharge. MDPI 2023-02-22 /pmc/articles/PMC10001136/ /pubmed/36900878 http://dx.doi.org/10.3390/ijerph20053868 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lassandro, Giulia
Tamburrini, Stefania
Liguori, Carlo
Picchi, Stefano Giusto
Pezzullo, Filomena
Ferrandino, Giovanni
Spinetti, Fabio
Vigliotti, Gennaro
Marano, Ines
Scaglione, Mariano
Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management
title Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management
title_full Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management
title_fullStr Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management
title_full_unstemmed Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management
title_short Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management
title_sort lower limb ischemia as acute onset of primary aortic occlusion: cta imaging and management
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10001136/
https://www.ncbi.nlm.nih.gov/pubmed/36900878
http://dx.doi.org/10.3390/ijerph20053868
work_keys_str_mv AT lassandrogiulia lowerlimbischemiaasacuteonsetofprimaryaorticocclusionctaimagingandmanagement
AT tamburrinistefania lowerlimbischemiaasacuteonsetofprimaryaorticocclusionctaimagingandmanagement
AT liguoricarlo lowerlimbischemiaasacuteonsetofprimaryaorticocclusionctaimagingandmanagement
AT picchistefanogiusto lowerlimbischemiaasacuteonsetofprimaryaorticocclusionctaimagingandmanagement
AT pezzullofilomena lowerlimbischemiaasacuteonsetofprimaryaorticocclusionctaimagingandmanagement
AT ferrandinogiovanni lowerlimbischemiaasacuteonsetofprimaryaorticocclusionctaimagingandmanagement
AT spinettifabio lowerlimbischemiaasacuteonsetofprimaryaorticocclusionctaimagingandmanagement
AT vigliottigennaro lowerlimbischemiaasacuteonsetofprimaryaorticocclusionctaimagingandmanagement
AT maranoines lowerlimbischemiaasacuteonsetofprimaryaorticocclusionctaimagingandmanagement
AT scaglionemariano lowerlimbischemiaasacuteonsetofprimaryaorticocclusionctaimagingandmanagement