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Lassandro G, Tamburrini S, Liguori C, Picchi SG, Pezzullo F, Ferrandino G, Spinetti F, Vigliotti G, Marano I, Scaglione M. Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3868. [PMID: 36900878 PMCID: PMC10001136 DOI: 10.3390/ijerph20053868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED 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.
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Affiliation(s)
- Giulia Lassandro
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Via Enrico Russo, 80147 Naples, Italy
| | - Stefania Tamburrini
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Via Enrico Russo, 80147 Naples, Italy
| | - Carlo Liguori
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Via Enrico Russo, 80147 Naples, Italy
| | - Stefano Giusto Picchi
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Via Enrico Russo, 80147 Naples, Italy
| | - Filomena Pezzullo
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Via Enrico Russo, 80147 Naples, Italy
| | - Giovanni Ferrandino
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Via Enrico Russo, 80147 Naples, Italy
| | - Fabio Spinetti
- Department of Vascular Surgery, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy
| | - Gennaro Vigliotti
- Department of Vascular Surgery, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy
| | - Ines Marano
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Via Enrico Russo, 80147 Naples, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, 21, 07100 Sassari, Italy
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Berner-Hansen V, Olsen AA, Brandstrup B. Endoscopic treatment of primary aorto-enteric fistulas: A case report and review of literature. World J Gastrointest Endosc 2021; 13:189-197. [PMID: 34163566 PMCID: PMC8209543 DOI: 10.4253/wjge.v13.i6.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/12/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary aorto-enteric fistula (PAEF) is a rare condition, traditionally treated in the acute, bleeding phase with open surgery or endovascular repair. However, these approaches have high morbidity and mortality, indicating a need for new methods. With advances in endoscopic techniques and equipment, haemoclipping of fistulas has now become feasible. Therefore, we present a systematic review of the English literature and a rare case of a PAEF successfully treated by endoscopic haemoclipping.
CASE SUMMARY A 74-year-old man with an abdominal aortic aneurysm presented with symptoms of haemorrhagic shock and bloody stools. An oesophago-gastro-duodenoscopy was performed with haemoclipping of a suspected PAEF in the third part of the duodenum. Afterward, a computed tomography-angiography showed a contrast filled protrusion from the abdominal aortic aneurysm. Based on the clinical presentation and the combined endoscopic and radiographic findings, we argue that this is a case of a PAEF.
CONCLUSION Endoscopic therapy appears capable of achieving haemodynamic stabilisation in patients with bleeding PAEF, serving as a bridge to final therapy.
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Affiliation(s)
- Victoria Berner-Hansen
- Department of Surgery, Holbaek Hospital, Part of Copenhagen University Hospitals, Holbaek 4300, Denmark
| | - August A Olsen
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Birgitte Brandstrup
- Department of Surgery, Holbaek Hospital, Part of Copenhagen University Hospitals, Holbaek 4300, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
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Sathiadoss P, Haroon M, Wongwaisayawan S, Krishna S, Sheikh AM. Multidetector Computed Tomography in Traumatic and Nontraumatic Aortic Emergencies: Emphasis on Acute Aortic Syndromes. Can Assoc Radiol J 2020; 71:322-334. [PMID: 32106708 DOI: 10.1177/0846537120902069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aortic emergencies comprise of a list of conditions which are uncommon but are potentially fatal. Prognosis is usually determined by emergent diagnosis and treatment and hence radiology plays a key role in patient management. In this article, we aim to review the various causes of aortic emergencies and the relevant imaging findings placing special emphasis on acute aortic syndromes.
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Affiliation(s)
- Paul Sathiadoss
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Mohammad Haroon
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Sirote Wongwaisayawan
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada.,Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Satheesh Krishna
- Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Adnan M Sheikh
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
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Ponnatapura J, Dyer RB. The "tangential calcium" sign. Abdom Radiol (NY) 2019; 44:2933-2934. [PMID: 31020350 DOI: 10.1007/s00261-019-02025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Janardhana Ponnatapura
- Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA.
| | - Raymond B Dyer
- Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA
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Abstract
Acute pathology in the abdominal aorta is associated with significant morbidity and mortality. The most feared complication of abdominal aortic disease is acute rupture in the setting of atherosclerotic abdominal aortic aneurysm. Although frank rupture often is easily diagnosed on CT, other findings such as a hyperattenuating crescent, discontinuous intimal calcium, and draping of the aorta are subtle signs of aneurysm instability. A true aneurysm should be distinguished from a rapidly growing, saccular pseudoaneurysm in the setting of infectious aortitis, as treatment strategy differs. Acute aortic syndrome involving the abdominal aorta, such as dissection and intramural hematoma, often is an extension of thoracic aortic disease, whereas penetrating atherosclerotic ulcers occasionally involve only the abdominal aorta. The goal of treating acute aortic pathology is to repair and prevent rupture, as well as restore and maintain perfusion of the lower extremities, kidneys, and mesentery. However, both open and endovascular repair of the abdominal aorta may become acutely complicated, resulting in compromise of these goals. Examples include aortoenteric fistula, endoleak, anastomotic pseudoaneurysm, graft infection, and thrombosis or kinking of a stent graft resulting in ischemia of the limbs and mesentery.
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Affiliation(s)
- William Curtis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA.
| | - Motoyo Yano
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA
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Fonseca EKUN, E Castro ADA, Tames ADVC, Jayme EM, Paiva OA, Sokolowski LR. The draped aorta sign of impending aortic aneurysm rupture. Abdom Radiol (NY) 2017; 42:2190-2191. [PMID: 28337519 DOI: 10.1007/s00261-017-1114-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Eduardo Kaiser Ururahy Nunes Fonseca
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil.
- Imaging Department, Hospital Municipal do M'boi Mirim Dr. Moysés Deutsch, Estrada do M'boi Mirim, 5203, São Paulo, 05868-160, Brazil.
| | - Adham do Amaral E Castro
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil
- Imaging Department, Hospital Municipal do M'boi Mirim Dr. Moysés Deutsch, Estrada do M'boi Mirim, 5203, São Paulo, 05868-160, Brazil
| | - Amanda de Vasconcelos Chambi Tames
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil
- Imaging Department, Hospital Municipal do M'boi Mirim Dr. Moysés Deutsch, Estrada do M'boi Mirim, 5203, São Paulo, 05868-160, Brazil
| | - Eduardo Matarolo Jayme
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil
- Imaging Department, Hospital Municipal do M'boi Mirim Dr. Moysés Deutsch, Estrada do M'boi Mirim, 5203, São Paulo, 05868-160, Brazil
| | - Omir Antunes Paiva
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil
- Imaging Department, Hospital Municipal do M'boi Mirim Dr. Moysés Deutsch, Estrada do M'boi Mirim, 5203, São Paulo, 05868-160, Brazil
| | - Luis Ricardo Sokolowski
- Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, São Paulo, 05652-901, Brazil
- Imaging Department, Hospital Municipal do M'boi Mirim Dr. Moysés Deutsch, Estrada do M'boi Mirim, 5203, São Paulo, 05868-160, Brazil
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