What's the Diagnosis? By Dr. Loran Hatch
A 65 yo M with a PMhx of CHF presents to the ED complaining of abdominal pain and back pain radiating to his bilateral lower extremities since earlier in the day. On exam, he appears uncomfortable and is noted to have an abdominal bruit. He is unable to move his lower extremities and DP pulses are absent bilaterally. A stat CTA chest/abdomen/pelvis is done and shown below. What's the diagnosis? (scroll down for answer)
Answer: Abdominal Aortic Occlusion
- The CT above demonstates marked atherosclertoic disease throughout the abdominal aorta with associated areas of severe focal stenosis of the infrarenal abdominal aorta. There is also multifocal occlusion of the bilateral common iliac, external iliac, and common femoral arteries with areas of reconstitution of flow
- Abdominal aortic occlusion is a vascular emergency!
- Causes: thrombotic occlusion, embolic occlusion, hypercoagulability, vasculitis
- Risk factors: hypertension, hyperlipidemia, DM, tobacco use
- Patients may present with sudden leg pain, paralysis, cold/pulseless extremities
- High risk of associated limb loss, rhabdomyolysis, acute renal failure and death
- Treatment is emergent revascularization w/ thrombecotmy or embolectomy followed by ICU monitoring
Dutu, Bogdan et al. “Symptomatic Total Aortic Occlusion.” The American journal of case reports vol. 19 589-592. 22 May. 2018.
Crawford JD, Perrone KH, Wong VW, et al. A modern series of acute aortic occlusion. J Vasc Surg. 2014;59(4):1044–50.