Acute Thrombosis of the Abdominal Aorta Secondary to Low Cardiac Output Syndrome

Acute aortic occlusion is a rare but catastrophic pathology with very high morbidity and mortality. It may result from thrombus formation, saddle embolism and other etiologies related to arteriosclerosis, low flow states or hypercoagulability. The clinical presentations include ischemic and neurologic symptoms of the lower extremities, abdominal symptoms and acute hypertension. We present a case of acute aortic occlusion resulting from in situ thrombosis secondary to a low cardiac output state due to MI. A 61-year-old man underwent sigmoid colon resection for volvulus formation 5 days before his acute presentation. He presented as acute inferior MI with low cardiac output syndrome. Successful stent implantation of the RCA was performed as an emergency via the right brachial artery since the femoral pulses were not palpable. Abdominal aortography showed total occlusion of the abdominal aorta distal to the renal arteries. Emergency bilateral femoral embolectomy was performed with local anesthesia, resulting in good distal pulses. Postoperatively, he deteriorated with acidosis, hypotension, oliguria and increased inotrop requirement. He died of cardiac failure and severe metabolic derangement on the second day after operation. Early diagmosis and treatment is very important for preventing metabolic compromise in these patients. The choice of surgical procedure depends on the general condition of the patient, the presence of chronic aortic occlusive disease, presence of renal and mesenteric ischemia and cardiac function of the patient. (JAREM 2012; 2: 124-6)