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Early Recognition And Management Of Acute Aortic Occlusion: A Hybrid Approach With CERAB
Mohammed I. Ali, MD, PhD, Gaurang Joshi, MD, Fari Fall, MD, Michael J. Nooromid, MD, Babak Abai, MD.
Thomas Jefferson University, Philadelphia, PA, USA.
Objective
We describe a case of bilateral acute lower extremity ischemia and weakness secondary to acute aortic occlusion, with subsequent repair via hybrid approach and covered endovascular reconstruction of the aortic bifurcation (CERAB).
Methods
We present a 72-year-old female with a complicated orthopedic surgical history presenting with left leg weakness and flank pain. Subsequent imaging demonstrated an acute occlusion of the left CIA and CFA with distal reconstitution. Initial operative course involved an embolectomy of the left iliofemoral vessels with restoration of distal flow. The subsequent hospital course was complicated by pelvic and back pain, bilateral lower extremity weakness; imaging revealed an acute aortic occlusion at the aortoiliac bifurcation. The patient underwent bilateral femoral cutdowns with an open thrombectomy without remarkable results, subsequent angiogram revealed persistent AIOD with significant flow limiting disease. Common iliac vessels demonstrated severe stenosis. We gained wire access from bilateral femoral arteries and snared the contralateral limb of an AFX2 device outside the body and guided it to the aorto-iliac junction. We subsequently performed a CERAB with significant improvement in distal flow. The patient recovered well post-procedure.
Results
Complex interventions on aneurysmal disease may involve hybrid interventions, but addressing an acute emergency in such a fashion requires a novel approach. Our case presents a unique emergency that may be translated into a protocoled approach for a time sensitive problem.
Conclusion
As we continue to push the envelope with endovascular repair of TASC D lesions, it becomes important for trainees and young faculty to be adept at hybrid repairs and management of challenging clinical scenarios.
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