PubMed · 8183757
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M A al-Kutoubi, L Kreel. 1994. Aortic calcification.. https://doi.org/10.1136/pgmj.70.821.213
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BACKGROUND: Duplex imaging has been shown to be as accurate as arteriography in detecting hemodynamically significant aorto-iliac stenosis or occlusions. METHODS: Review of the duplex scan and arteriogram reports for all primary aorto-iliac reconstructions performed during an 18-month period was undertaken. Deviations from the preoperatively planned procedure were determined. The role of the duplex scan on procedure selection was assessed. RESULTS: Of the 54 patients identified, 13 had both duplex scan and arteriography (group I), 30 had only arteriography (group II), and 11 had only duplex scans (group III). Ten group I, 15 group II, and 9 group III patients had an occluded aorta or iliac artery. Two patients (3 anastomosis) required placement of the distal anastomosis on the common femoral rather than the external iliac artery as planned preoperatively. Both had been arteriogrammed. No group III patient required deviation from the preoperative plan. CONCLUSION: Aorto-iliac reconstruction can be performed without arteriography when a totally occluded aorta or iliac artery is identified by duplex scanning.
A 62-year old patient was admitted with a 24-hour history of ischemia in both legs caused by acute distal aortic occlusion and had had a total loss of sensitivity and motor function for 8 hours. Preoperative serum creatine phosphokinase level was 10,900 IU/ml. During aortofemoral reconstruction, both limbs were reperfused with a potassium-free, blood-cardioplegia-like perfusate. Fasciotomies were not necessary. After operation, maximal serum creatine phosphokinase levels remained below 10,000 IU/ml. Limb sensitivity and motor function were normal. Even for prolonged acute aortoiliac occlusion, a simplified controlled limb-reperfusion may preserve skeletal muscle and nerve function and prevent local and systemic complications caused by reperfusion damage.
With the advent of transesophageal echocardiography, aortic atheromatosis has emerged as an important source of cerebral embolization. Mobile atheromatous plaque in the ascending aorta and aortic arch has been shown to constitute a strong and independent risk factor in patients with stroke. In patients undergoing coronary bypass surgery, it is the single most important contributing factor to perioperative neurologic morbidity. Emboli originating in the heart, aorta, and proximal cerebral vasculature have been observed intraoperatively in patients undergoing coronary bypass surgery, especially when aortic clamps are released. The constitution of these emboli is unclear, although an indeterminate fraction undoubtedly represents dislodged atheromatous material. The impact of such embolization in terms of neurologic outcome is currently under investigation. Prevention of embolization from mobile aortic atheroma in patients undergoing cardiac surgery may require modification of surgical technique. Secondary prevention in patients with a history of embolization can only be determined once the natural history of such lesions is established.