Point-of-care Ultrasound Diagnosis of Acute Abdominal Aortic Occlusion

Acute aortic occlusion: A narrative review for emergency clinicians

INTRODUCTION

Acute aortic occlusion (AAO) is a rare but serious condition associated with significant morbidity and mortality.

OBJECTIVE

This review provides an emergency medicine focused evaluation of AAO, including presentation, assessment, and emergency department (ED) management based on current evidence.

DISCUSSION

AAO refers to obstruction of blood flow through the aorta due to either thrombosis or embolism. This condition primarily affects older adults ages 60-70 with cardiovascular comorbidities and most commonly presents with signs and symptoms of acute limb ischemia, though the gastrointestinal tract, kidneys, and spinal cord may be affected. The first line imaging modality includes computed tomography angiography of the chest, abdomen, and pelvis. ED resuscitative management consists of avoiding extremes of blood pressure or heart rate, maintaining normal oxygen saturation and euvolemic status, anticoagulation with heparin, and pain control. Emergent consultation with the vascular surgery specialist is recommended to establish a plan for restoration of perfusion to ischemic tissues via endovascular or open techniques. High rates of baseline comorbidities present in the affected population as well as ischemic and reperfusion injuries place AAO patients at high risk for complications in an immediate and delayed fashion after surgical management.

CONCLUSIONS

An understanding of AAO can assist emergency clinicians in diagnosing and managing this rare but devastating disease.

Role of POCUS in Assessing an Acute Aortic Thrombus

A 67-year-old female patient presented with abdominal pain with a recent diagnosis of paroxysmal atrial fibrillation. Computed tomography (CT) of the abdomen demonstrated a filling defect concerning for an aortic thrombus. Point of care ultrasound (POCUS) confirmed a mobile thrombus in the proximal abdominal aorta in close proximity to several major arterial branches, leading to urgent surgical consultation due to a concern for mesenteric and end-organ ischemia. POCUS played a role in determining patient management in this novel case, and the patient was anticoagulated and ultimately discharged from the hospital.