Acute Occlusion of Abdominal Aorta: a case report

Laforteza, Pearl Margaret; Listanco, Olivia Faye; Mercado, Genesis

Abstract:

CASE REPORT
A 80 year old hypertensive non-smoker female Filipino with chronic atrial fibrillation
was admitted to our hospital for right leg pain. The patient had a three day history
of right leg pain described as dull and steady, associated with bipedal edema and
difficulty in ambulation. She then sought consult at a local hospital given
Furosemide and pain medications. Medications provided slight resolution of bipedal
edema however pain persisted. She then sought another consult to another
hospital, where Doppler ultrasound of the lower extremities showed occlusion of the
right popliteal artery. Patient was managed as a case of acute limb ischemia.
Initially given 5000 unit of heparin bolus intravenously and started on heparin drip
at 500 unit/hour and transferred to our intuition. Patient was manged as a case
acute lim ischemia stage III. Her physical examinations revealed cold to touch right
ankle and foot with decreased right femoral pulse and absent right popliteal and
dorsalis pedis pulses. Left leg was warm and with strong to moderate femoral,
popliteal and dorsalis pedis pulses. No external lesion or cyanosis was reported.
Contrast-enhanced MR angiography of the abdominal aorta to the lower extremities
run-off revealed severe stenosis involving the distal abdominal aorta inferior to the
inferior mesenteric artery extending to the aorto-iliac bifurcation and proximal iliac
arteries bilaterally. Marked complete or severe stenosis was noted proximal right
common iliac artery. Moderate to severe stenosis of the proximal left common iliac
artery and severe stenosis involving the right superficial right femoral arter amd
moderate occlusion at the popliteal artery were described.
Immediate relief of the occlusion was performed with bilateral femoral exploration,
axillo-femoral thrombolectomy, right femoral edarterctomy, vein patch repair of
bilateral femoral artery and above the knee amputation on the right leg. Heparin
drip was titrated accordingly based on the serial determination of the partial
prothrombin time and was discontinued 6 hours prior to the operation. Post
operatively heparin drip was continued at 700 unit/ hour and was titrated based og
the partial prothronbin time, and eventually overlap with warfarin was started and
drip was discontinued.
Incidental finding of a hypodense focus with necrotic center was also noted on the
first MRA hence a follow up was done, which revelead _____________.