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Initial Management and Recognition of Aortoiliac Occlusive Disease, A Case Report.

ABSTRACT: Aortoiliac occlusive disease (AOD) is a manifestation of peripheral arterial disease characterized by stenosis or occlusion of the distal aorta and iliac vessels. Advanced disease may present with symptoms of claudication to the buttock and thighs, erectile dysfunction, and absent or diminished femoral pulses bilaterally. Here, we discuss a case of a 71-year-old male who presented with acute bilateral lower extremity pain and weakness. Pulses were undetectable bilaterally at the groin prompting emergent imaging and vascular surgery consultation due to the suspected diagnosis of AOD. The patient was taken for bilateral femoral artery cut downs with embolectomy. The patient made an impressive recovery with preservation of motor function of lower extremities. In this case report we discuss pertinent workup and management of a patient suspected to be suffering from AOD.

Topics

Vascular, arterial thrombosis, limb ischemia, aortoiliac arterial thrombosis, Leriche syndrome, peripheral arterial disease.

SUBMITTER: Hope A

PROVIDER: S-EPMC10358871 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Initial Management and Recognition of Aortoiliac Occlusive Disease, A Case Report.

Hope Ashley A Wray Alisa A Stephenson Graham G

Journal of education & teaching in emergency medicine 20220115 1

Aortoiliac occlusive disease (AOD) is a manifestation of peripheral arterial disease characterized by stenosis or occlusion of the distal aorta and iliac vessels. Advanced disease may present with symptoms of claudication to the buttock and thighs, erectile dysfunction, and absent or diminished femoral pulses bilaterally. Here, we discuss a case of a 71-year-old male who presented with acute bilateral lower extremity pain and weakness. Pulses were undetectable bilaterally at the groin prompting ...[more]

PMID: 37483394

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Project description:ObjectivePatients presenting with occluded aortobifemoral (ABF) bypass grafts are managed with a variety of techniques. Redo ABF (rABF) bypass procedures are infrequently performed because of concerns about procedural complexity and morbidity. The purpose of this analysis was to compare midterm results of rABF bypass with those of primary ABF (pABF) bypass for aortoiliac occlusive disease to determine if there are significant differences in outcomes.MethodsA retrospective review was performed of all patients undergoing ABF bypass for occlusive disease between January 2002 and March 2012. A total of 19 patients underwent rABF bypass and 194 received pABF bypass during that period. Data for an indication- and comorbidity-matched case-control cohort of 19 elective pABF bypass patients were collected for comparison to the rABF bypass group. Primary end points included rate of major complications as well as 30-day and all-cause mortality. Secondary end points were amputation-free survival and freedom from major adverse limb events.ResultsThe rABF bypass patients more frequently underwent prior extra-anatomic or lower extremity bypass operations compared with pABF bypass patients (P = .02); however, no difference was found in the incidence of prior failed endovascular iliac intervention (P = .4). By design, indications for the rABF and pABF bypass groups were the same (claudication, n = 6/6 [31.6%]; P = 1; critical limb ischemia, n = 13/13 [78.4%]; P = 1). Aortic access was more frequently by retroperitoneal exposure in the rABF bypass group (n = 13 vs n = 1; P < .0001), and a significantly higher proportion of the rABF bypass patients required concomitant infrainguinal bypass or intraprocedural adjuncts such as profundaplasty (n = 14 vs n = 5; P = .01). The rABF bypass patients experienced greater blood loss (1097 ± 983 mL vs 580 ± 457 mL; P = .02), received more intraoperative fluids (3400 ± 1422 mL vs 2279 ± 993 mL; P = .01), and had longer overall procedure times (408 ± 102 minutes vs 270 ± 48 minutes; P < .0001). Length of stay (days ± standard deviation) was similar (pABF bypass, 11.2 ± 10.4; rABF bypass, 9.1 ± 4.5; P = .7), and no 30-day or in-hospital deaths occurred in either group. Similar rates of major complications occurred in the two groups (pABF bypass, n = 6 [31.6%]; rABF bypass, n = 4 [21.1%]; observed difference, 9.5%; 95% confidence interval, -17.6% to 36.7%; P = .7). Two-year freedom from major adverse limb events (±standard error mean) was 82% ± 9% vs 78% ± 10% for pABF and rABF bypass patients (log-rank, P = .6). Two-year amputation-free survival was 90 ± 9% vs 89 ± 8% between pABF and rABF bypass patients (P = .5). Two-year survival was 91% ± 9% and 90% ± 9% for pABF and rABF bypass patients (P = .8).ConclusionsPatients undergoing rABF bypass have higher procedural complexity compared with pABF bypass as evidenced by greater operative time, blood loss, and need for adjunctive procedures. However, similar perioperative morbidity, mortality, and midterm survival occurred in comparison to pABF bypass patients. These results support a role for rABF bypass in selected patients.

Project description:PurposeTo evaluate short- and long-term technical and clinical outcomes after kissing stent treatment of aortoiliac occlusive disease (AIOD) based on an individual participant data (IPD) meta-analysis.Materials and methodsA search of the Scopus database identified 156 articles on KS treatment of AIOD; of these 22 met the inclusion criteria. Authors of 19 articles with contact information were approached to join an IPD consortium. Eight author groups responded and 5 provided anonymized data for merging into an IPD database. The number of included procedures was equal before and after 2005. The primary study outcome was the cumulative patency at 24 months. Secondary outcomes were patency at up to 60 months, complications, and changes in Rutherford category and ankle-brachial index. The predictive value of stent protrusion length, pre-/postdilation, stent type, and patient demographics on primary patency were examined with Cox proportional hazard modeling; outcomes are reported as the hazard ratio (HR). The Kaplan-Meier method was employed to estimate patency rates.ResultsIn total, 605 (40.9%) of 1480 patients presented in the literature were included in the IPD analysis. The indication for intervention was intermittent claudication in 84.2% and critical limb ischemia in 15.8%. Lesions were classified as TransAtlantic Inter-Society Consensus (TASC) A or B in 52.8% and TASC C and D in 47.2%. The overall primary patency estimate was 81% at 24 months. Primary patency significantly increased after 2005 (p=0.005). Cox regression analysis revealed only age as a significant predictor of sustained primary patency (HR 0.60, p<0.005). Any previous endovascular intervention (HR 2.52, p=0.02) was the main predictor for loss of secondary patency; history of cardiovascular disease (HR 0.27, p=0.04) was the main predictor of sustained secondary patency.ConclusionThe kissing stent technique has a good safety profile and acceptable patency rates up to 2 years, even in TASC C and D lesions, supporting an endovascular-first approach for AIOD.

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Initial Management and Recognition of Aortoiliac Occlusive Disease, A Case Report.

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Initial Management and Recognition of Aortoiliac Occlusive Disease, A Case Report.

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