Acute aortic occlusion

Cilj: Cilj ovog rada je prikazati akutnu aortalnu okluziju, stanje hitnoće, često nazivano i „vaskularnom katastrofom” zbog toga što nosi lošu prognozu. To je stanje dijagnostički izazov jer zahtijeva rano prepoznavanje i hitno liječenje. Prikazat ćemo dva slučaja akutne aortalne okluzije. Prikaz slučaja: U oba slučaja bolesnici su se javili u hitnu službu Kliničke bolnice Dubrava; radilo se o ženama između 55 i 65 godina, kojima se nakon prethodne bolesti pogoršalo stanje u smislu bola u obje noge. Jedna je bolesnica imala i osjećaj slabosti u obje noge te neurološke ispade na prijemu, dok su se kod druge bolesnice našli samo znaci arterijske insuficijencije (hladni ekstremiteti i odsutnost pulsa). U prvom slučaju učinili smo pregled doplerom dupleksom koji je pokazao niske brzine protoka u obje arterije femoralis superficialis s PSV-om (engl. peak systolic velocity) manjim od 5 cm/sek te izmijenjene spektre, što u prvom redu upućuje na proksimalnu patologiju. Višeslojna kompjutorizirana tomografija (engl. multi-slice computerised tomography; MSCT) angiografija abdominalne aorte pokazala je trombotske mase abdominalne aorte u infrarenalnom dijelu, koje u potpunosti ispunjavaju lumen. Učinjena je trombektomija infrarenalne aorte. U drugom slučaju odmah smo pristupili MSCT angiografiji abdominalne aorte prema standardnom protokolu u hitnoj službi, koji pokaže potpunu okluziju aorte iznad bifurkacije uz prisutnu okluziju obje ilijačne arterije. Učinjena je Fogartyjeva embolektomija. Rasprava i zaključak: Radi se o rijetkom stanju koje je lako previdjeti, premda se karakteristično očituje. Pravilno postavljena indikacija za slikovne metode i njihovo izvođenje od krucijalne je važnosti za dijagnozu stanja koje se liječi kirurški te nosi visok mortalitet.Aim: Aim of this article is to present acute aortic occlusion as an emergent vascular event, often called ”vascular catastrophe” because of its poor prognosis. It is a diagnostic challenge because it requires early recognition and urgent intervention. We will present two cases of acute aortic occlusion. Case report: In both cases, patients referred to the Emergency Department of the Clinical Hospital Dubrava. Both patients were female, from 55 to 65 years, who presented pain in both legs as deterioration in their condition. One patient had weakness in both legs and neurological symptoms, and the other one had only signs of arterial insufficiency (cold extremities and absence of pulse). In the first case we started with duplex doppler examination, which showed low flow velocities in both superficial femoral arteries with peak systolic velocity lower than 5cm/sec and changed spectra indicating proximal pathology. Multi-slice computerized tomography (MSCT) angiography of abdominal aorta showed thrombosis in infrarenal part of the abdominal aorta which completely filled the lumen. Thrombectomy of the infrarenal aorta was performed. In the second case, we immediately performed MSCT angiography of abdominal aorta by standard protocol in emergency department, which showed complete occlusion of the aorta above the bifurcation and occlusion of both common iliac arteries. Fogarty embolectomy was performed. Discussion and conclusion: Acute aortic occlusion is a rare condition which is easy to overlook, but has a characteristic presentation. A proper indication for imaging methods is of crucial importance for diagnosis of this condition which is treated with surgical methods and has a high mortality