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The records of 302 patients who underwent abdominal aortic aneurysm (AAA) repair between
1985 and 1990 were reviewed. Two hundred and forty-eight patients (82%) were asymptomatic,
while 32 patients (11%) had ruptured aneurysms. During this period, 15 patients (5%)
presented with distal embolization as the first manifestation of their AAA. The preoperative
embolic event resulted in limb-threatening ischemia in 3 patients, digital ischemia
in 11, and calf myonecrosis in 1. CT scan was performed in 14 of 15 patients demonstrating
irregular, heterogeneous thrombus within the AAA. Only two of the AAAs were larger
than 5 cm. Angiography demonstrated occlusive lesions but was not diagnostic for AAA
in seven patients and resulted in three episodes of embolization. AAA was repaired
with a tube graft in 4 patients while a bifurcated graft was required in 11 patients
for aneurysmal (in 4 patients) and occlusive disease (in 7 patients) of the iliac
arteries. All cases employed a transperitoneal approach, systemic heparin, and distal
occlusion prior to aortic clamping. Complications included three major (below-knee)
and five minor amputations, developing or worsening renal failure in five patients
(33%), and death in two (13%). In comparison, mortality was 5% for elective repair
and 66% for rupture during this same period.
CT scan was safer and more informative than angiography. The morbidity of patients
with AAA presenting with emboli is comparable with rupture. The risk of embolization
does not correlate with size and indicates the potentially dangerous nature of small
AAAs.
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Article info
Footnotes
2Presented at the 18th Annual Meeting of the Society for Clinical Vascular Surgery, Palm Desert, California, March 7–11, 1990.
Identification
Copyright
© 1990 Reed Publishing USA. Published by Elsevier Inc.
