cardiovascular disorders
Abdominal Aortic Branch Occlusion
Treatment of Abdominal Aortic Branch Occlusion
Embolectomy or percutaneous transluminal angioplasty for acute occlusion Surgery or angioplasty for chronic, severe occlusion Acute occlusion is a surgical emergency requiring embolectomy or percutaneous transluminal angioplasty (PTA) with or without stent placement. A laparotomy with bypass graft and bowel resection may be necessary if embolectomy or PTA is unsuccessful. Chronic occlusion, if symptomatic, may require surgery or angioplasty. Risk factor modification and antiplatelet medications may help. Acute mesenteric occlusion (eg, in the superior mesenteric artery), which causes significant morbidity and mortality, requires prompt revascularization. Prognosis is poor if the intestine is not revascularized within 4 to 6 hours. For chronic occlusion of the superior mesenteric artery and celiac axis, dietary modifications may temporarily relieve symptoms. If symptoms are severe, surgical bypass from the aorta to the splanchnic arteries distal to the occlusion usually results in revascularization. Long-term patency of the grafts exceeds 90%. In appropriately selected patients (particularly among older patients who may be poor candidates for surgery), revascularization by PTA with or without stent placement may be successful. Symptoms may resolve rapidly, and weight may be regained. Acute renal artery occlusion requires embolectomy; sometimes PTA can be done. Initial treatment of chronic occlusion involves Medications for Hypertension . If blood pressure is not controlled adequately or if renal function deteriorates, PTA with stent placement or, when PTA is impossible, open surgical bypass or endarterectomy can improve blood flow. Occlusion of the aortic bifurcation requires urgent embolectomy, usually done transfemorally. If chronic occlusion of the aortic bifurcation causes claudication, an aortoiliac or aortofemoral graft can be used to surgically bypass the occlusion. PTA is an alternative for selected patients. 