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Home > Vascular Annual Meeting > PP48. Chronic Atherosclerotic Occlusion of the...

PP48. Chronic Atherosclerotic Occlusion of the Abdominal Aorta: A Contemporary Experience of Open Abdominal Aortic Reconstruction

Charles A. West, Jr.1, Linda Doucet1, Gloria Caldito1, Lester Johnson, Sr.2, Dale Speir1
1Louisiana State University Health Science Center, Shreveport, LA; 2Louisiana State University Health Science Center-EA Conway, Monroe, LA

OBJECTIVES: Chronic atherosclerotic abdominal aortic occlusion (CAAAO) is a rare and complex form of aortic disease. Few modern series reviewing abdominal aortic reconstruction for CAAAO exist. Thus, we sought to examine a current experience reviewing surgical techniques and outcomes.

METHODS: between January 1997 through December 2008, 51 patients with CAAAO were identified and retrospectively reviewed. CAAAOs were categorized into pararenal aortic occlusions (PRAO’s) and infrarenal aortic occlusions (IRAO’s) based on superior extension of thrombus and requirement for supra-renal aortic clamping (SR-AC). Mortality, morbidity, hospital stay and operative variables were assessed. Univariate analyses were performed to test for associations between operative variables and primary outcomes.

RESULTS: Fifty patients were treated. 47 underwent aortic reconstructions with aorto-bifemoral or iliac (ABF-I) bypass and 3 had axillo-bifemoral (AXBF) repairs. There were 32 males, 18 females (mean age 53 years, range 32-72). Severe claudication was present in 32, 17 had critical limb ischemia (CLI) and 1 presented with ARF. There were 31 PRAOs and 20 IRAOs. IRAOs had infrarenal clamps (IRC) and aortic engraftment. In PRAOs, (SR-AC) was employed with aortorenal- thromboendarterectomy (AR-TEA) in (24/30) 76%, 3 AR-TEA’s were blind with IRC and 3 AXBFs were performed. Of  PRAO’s with AR-TEA, repairs were end-to-end: 14 sewn to the renal bearing aorta; 10 were infrarenal after longitudinal pararenal aortotomy, AR-TEA and primary aortic closure. Renal revascularization was required in only 12% (6/50). Operative mortality at 30 days was 0. Cardio-pulmonary dysfunction occurred in 4 (8%). Post-operative renal insufficiency was found in 10 (20%). Temporary dialysis was required in 1 (2 %). Those with renal insufficiency in the post-operative period recovered to baseline at discharge. Median ICU and hospital stay were 3 and 7 days respectively. Analysis reveals associations only between prolonged hospital stay and intra-operative blood replacement (p=0.001).

CONCLUSIONS: Abdominal aortic reconstruction is a safe method for treating CAAAO. In CAAAO, SR-AC followed by AR-TEA and aortic replacement is an effect solution for pararenal aortic disease and can be performed without significant renal impairment.

AUTHOR DISCLOSURES: C.A. West, None; L. Doucet, None; G. Caldito, None; L. Johnson, None; D. Speir, None.