Distal embolization as a presenting symptom of aortic aneurysms

Bernard Timothy Baxter, Gregory S. McGee, William R. Flinn, Walter J. McCarthy, William H. Pearce, James S.T. Yao

Research output: Contribution to journalArticle

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Abstract

The records of 302 patients who underwent abdominal aortic aneurysm (AAA) repair between 1985 and 1990 were reviewed. Two hundred and forty-eight patients (82%) were asymptomatic, while 32 patients (11%) had ruptured aneurysms. During this period, 15 patients (5%) presented with distal embolization as the first manifestation of their AAA. The preoperative embolic event resulted in limb-threatening ischemia in 3 patients, digital ischemia in 11, and calf myonecrosis in 1. CT scan was performed in 14 of 15 patients demonstrating irregular, heterogeneous thrombus within the AAA. Only two of the AAAs were larger than 5 cm. Angiography demonstrated occlusive lesions but was not diagnostic for AAA in seven patients and resulted in three episodes of embolization. AAA was repaired with a tube graft in 4 patients while a bifurcated graft was required in 11 patients for aneurysmal (in 4 patients) and occlusive disease (in 7 patients) of the iliac arteries. All cases employed a transperitoneal approach, systemic heparin, and distal occlusion prior to aortic clamping. Complications included three major (below-knee) and five minor amputations, developing or worsening renal failure in five patients (33%), and death in two (13%). In comparison, mortality was 5% for elective repair and 66% for rupture during this same period. CT scan was safer and more informative than angiography. The morbidity of patients with AAA presenting with emboli is comparable with rupture. The risk of embolization does not correlate with size and indicates the potentially dangerous nature of small AAAs.

Original languageEnglish (US)
Pages (from-to)197-201
Number of pages5
JournalThe American Journal of Surgery
Volume160
Issue number2
DOIs
StatePublished - Jan 1 1990

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Aortic Aneurysm
Abdominal Aortic Aneurysm
Rupture
Angiography
Ischemia
Transplants
Ruptured Aneurysm
Iliac Artery
Embolism
Amputation
Constriction
Renal Insufficiency
Heparin
Knee
Thrombosis
Extremities

ASJC Scopus subject areas

  • Surgery

Cite this

Baxter, B. T., McGee, G. S., Flinn, W. R., McCarthy, W. J., Pearce, W. H., & Yao, J. S. T. (1990). Distal embolization as a presenting symptom of aortic aneurysms. The American Journal of Surgery, 160(2), 197-201. https://doi.org/10.1016/S0002-9610(05)80306-X

Distal embolization as a presenting symptom of aortic aneurysms. / Baxter, Bernard Timothy; McGee, Gregory S.; Flinn, William R.; McCarthy, Walter J.; Pearce, William H.; Yao, James S.T.

In: The American Journal of Surgery, Vol. 160, No. 2, 01.01.1990, p. 197-201.

Research output: Contribution to journalArticle

Baxter, BT, McGee, GS, Flinn, WR, McCarthy, WJ, Pearce, WH & Yao, JST 1990, 'Distal embolization as a presenting symptom of aortic aneurysms', The American Journal of Surgery, vol. 160, no. 2, pp. 197-201. https://doi.org/10.1016/S0002-9610(05)80306-X
Baxter, Bernard Timothy ; McGee, Gregory S. ; Flinn, William R. ; McCarthy, Walter J. ; Pearce, William H. ; Yao, James S.T. / Distal embolization as a presenting symptom of aortic aneurysms. In: The American Journal of Surgery. 1990 ; Vol. 160, No. 2. pp. 197-201.
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