Aortic Dissection and Thrombosis Diagnosed by Emergency Ultrasound in a Patient with Leg Pain and Paralysis

The authors present a case of aortic dissection and abdominal aortic aneurysm thrombosis in a 78-year-old male who presented to the emergency department (ED) complaining of lower extremity and paralysis for the past 1.5 hours. The initial vital signs in the ED were as follows: blood pressure (BP) 132/88 mmHg, heart rate (HR) 96, respiratory rate (RR) 14, and an oxygen saturation of 94% at room air. Physical exam was notable for pale and cold left leg. The ED physician was unable to palpate or detect a Doppler signal in the left femoral artery. Bedside ultrasound was performed which showed non-pulsatile left femoral artery and limited flow on color Doppler. Abdominal aortic aneurysm screening ultrasound was performed showing a 4.99 cm infrarenal abdominal aortic aneurysm and an intra-aortic thrombus with an intimal flap. Vascular surgery was promptly contacted and the patient underwent emergent aorto-bi-femoral bypass, bilateral four compartment fasciotomy, right common femoral artery endarterectomy with profundoplasty, and subsequent left leg amputation. Emergency physicians should utilize bedside ultrasound in patients who present with risk factors or threatening signs and symptoms that may suggest aortic dissection or aneurysm. Bedside ultrasound decreases time to definitive treatment and the mortality of the patients.

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Visceral segment aortic thrombus is associated with proximal aortic degeneration after infrarenal abdominal aortic aneurysm repair

Vascular ◽

10.1177/17085381211021282 ◽

2021 ◽

pp. 170853812110212

Author(s):

Sean P Steenberge ◽

Daniel G Clair ◽

Matthew J Eagleton ◽

Francis J Caputo ◽

Christopher J Smolock ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysm Repair ◽

Infrarenal Abdominal Aortic Aneurysm ◽

Abdominal Aortic ◽

Aortic Thrombus ◽

Aneurysm Development ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Objective To identify predictors of aortic aneurysm formation at or above an infrarenal abdominal aortic aneurysm repair. Methods A total of 881 infrarenal abdominal aortic aneurysm repairs were identified at a single institution from 2004 to 2008; 187 of the repairs were identified that had pre-operative and post-operative computed tomography imaging at least one year or greater to evaluate for aortic degeneration following repair. Aortic diameters at the celiac, superior mesenteric, and renal arteries were measured on all available computed tomographic scans. Aortic thrombus and calcification volumes in the visceral and infrarenal abdominal aortic segments were calculated. Multivariable modeling was used with log transformed variables to determine potential predictors of future aortic aneurysm development after infrarenal abdominal aortic aneurysm repair. Results Of the 187 patients in the cohort, 100 had an open abdominal aortic aneurysm repair while 87 were treated with endovascular repair. Proximal aortic aneurysms developed in 26% ( n = 49) of the cohort during an average of 72 ± 34.2 months of follow-up. After multivariable modeling, visceral segment aortic thrombus on pre-operative computed tomography imaging increased the risk of aortic aneurysm development above the infrarenal abdominal aortic aneurysm repair within both the open abdominal aortic aneurysm (hazard ratio 2.04, p = 0.033) and endovascular repair (hazard ratio 3.31, p = 0.004) cohorts. Endovascular repair was independently associated with a higher risk of future aortic aneurysm development after infrarenal abdominal aortic aneurysm repair when compared to open abdominal aortic aneurysm (hazard ratio 2.19, p = 0.025). Conclusions Visceral aortic thrombus present prior to abdominal aortic aneurysm repair and endovascular repair are both associated with an increased risk of future proximal aortic degeneration after infrarenal abdominal aortic aneurysm repair. These factors may predict patients at higher risk of developing proximal aortic aneurysms that may require complex aortic repairs.

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Usefulness of Transesophageal Echocardiography in Guiding Acute Aortic Dissection Management During Open Repair of an Abdominal Aortic Aneurysm

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2015.07.027 ◽

2016 ◽

Vol 30 (3) ◽

pp. 725-728

Author(s):

Atsushi Kainuma ◽

Masayuki Ihara ◽

Ikuko Miyawaki ◽

Hiroyuki Mima ◽

Tadaaki Koyama ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Aortic Dissection ◽

Transesophageal Echocardiography ◽

Acute Aortic Dissection ◽

Open Repair ◽

Abdominal Aortic

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Ruptured abdominal aortic aneurysm masquerading as isolated hip pain: an unusual presentation

CJEM ◽

10.1017/s1481803500010186 ◽

2008 ◽

Vol 10 (03) ◽

pp. 251-254 ◽

Cited By ~ 8

Author(s):

Sriram Vaidyanathan ◽

Himanshu Wadhawan ◽

Pedro Welch ◽

Murad El-Salamani

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Effective Means ◽

Hip Pain ◽

Definitive Treatment ◽

Ruptured Abdominal Aortic Aneurysm ◽

Emergency Physicians ◽

Catastrophic Event ◽

Abdominal Aortic ◽

First Contact

ABSTRACT The rupture of an abdominal aortic aneurysm (AAA) is a catastrophic event. Misdiagnosis by first-contact emergency physicians remains a serious concern. Varied and frequently nonspecific presentations lead to erroneous diagnostic impressions and cause significant delays in definitive intervention. We report the case of a 73-year-old man with a ruptured AAA presenting with isolated acute right hip pain without any classical features such as truncal pain or hypotension. Despite major advances in imaging and definitive treatment, a heightened awareness among emergency physicians remains the only effective means of improving detection and thereby survival.

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Endovascular Abdominal Aortic Aneurysm Repair through a Persistent Sciatic Artery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000188 ◽

2015 ◽

Vol 10 (5) ◽

pp. 354-356

Author(s):

Rajesh Ramanathan ◽

Michelle L. DesChamplain ◽

Derek R. Brinster

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Femoral Artery ◽

Arterial System ◽

Persistent Sciatic Artery ◽

Infrarenal Aortic Aneurysm ◽

Open Operation ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Conventional access for endovascular infrarenal aortic aneurysm repair is through the femoral artery. In rare circumstances, an anomalous persistent sciatic artery may replace the femoral arterial system as the main blood supply of the lower extremity. We report the case of a 64-year-old woman with a rapidly expanding infrarenal abdominal aortic aneurysm. Preoperative computed tomography revealed a right persistent sciatic artery with an ipsilateral atrophic femoral artery. Her aortic aneurysm was successfully repaired using an endovascular approach with access through the right persistent sciatic artery and contralateral femoral artery. A persistent sciatic artery can be used as an access for endovascular treatment of an infrarenal aortic aneurysm. This technique can be extrapolated to the treatment of distal or contralateral aneurysms, precluding the need for open operation.

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ASCENDING AORTIC ANEURYSM – A CASE REPORT

Journal Of Healthcare In Developing Countries ◽

10.26480/jhcdc.03.2021.54.55 ◽

2020 ◽

Vol 1 (3) ◽

pp. 54-55

Author(s):

Prathap Kumar. J.

Keyword(s):

Abdominal Aortic Aneurysm ◽

Case Report ◽

Aortic Aneurysm ◽

Ascending Aorta ◽

Leg Pain ◽

Ultrasound Screening ◽

Ascending Aortic Aneurysm ◽

Risk Of Mortality ◽

Abdominal Aortic ◽

Life Threatening

An aortic aneurysm is an abnormal dilation of the aorta to greater than 1.5 times its normal size. They usually cause no symptoms except when ruptured. Occasionally, there may be symptoms like abdominal, back, or leg pain. They are most commonly located in the abdominal aorta, but can also be located in the thoracic aorta, rarely in arch of aorta. Abdominal aortic aneurysm is more common in men, a disease that is often asymptomatic and has up to a 90% risk of mortality if the aneurysm ruptures. It can be easily diagnosed by an ultrasound screening, and if the aneurysm is > 5.5 cm, it can be surgically repaired to prevent a life-threatening rupture. Aneurysm of the ascending aorta is rare but can be easily diagnosed by echocardiogram.

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