J.Jpn. Surg. Soc.. 80(11): 1106-1110, 1979

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Report on the annual meeting

SURGERY FOR COMPLETE OCCLUSION OF ABDOMINAL AORTA

Sixteen patients with atherosclerotic occlusion of the abdominal aorta have been studied. Ten patients had juxtarenal aortic occlusion, among whom 3 patients were associated with thrombosis of their unilateral renal arteries. In the other 6 patients, the proximal level of occlusion was between the aortic bifurcation and several cm. below the renal artery. All patients were presented with claudication of the lower extremities, which included disabling claudication in four patients. In 44%, more advanced symptoms of vascular insufficiency were documented, which included rest pain, gangrene and ulceration of the legs. Two patients, early in the series, had only thromboendarterctomy. Eleven patients underwent aorto-iliac or femoral bypass, in association with thromboendoarterctomy of the infrarenal aorta. Two patients showing renovascular hypertension were added nephrectomy and patchangioplasty, respectively. To the remaining 3 patients, axillofemoral bypass (two poor risk patients) and descendofemoral bypass were performed. There were two operative deaths and one early occlusion (one limb). On follow-up study, 8 patients among 9 survivers have been documented satisfactory graft patency.
Complete occlusion of the abdominal aorta is suspected to be of poor prognosis. When untreated, progression of the vascular insufficiency almost always leads to gangrene and proximal propagation of aortic thrombus may involve the renal artery or the visceral arteries. Such a threat of the visceral artery thrombosis supports a definit indication for surgery. Bypass from the abdominal aorta to the iliac or femoral artery associated with thromboendoarterectomy of the infrarenal aorta is the safer method and provides satisfactory result.

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