Follow up Studies of Patients with Embolie Occlusion of the Aortic Bifurcation

Abstract

EMBOLIC occlusion of the terminal aorta usually is a dramatic and too frequently a fatal complication of pre-existing cardiac disease. Although saddle emboli are relatively uncommon, they are acute emergencies that must be promptly recognized and aggressively treated if lives and limbs are to be saved Taylor10 noted an incidence of approximately three per year in a hospital population of 2,000. Haimovici16 found 30 cases (9.1%) among 330 unselected peripheral emboli to the extremities, collected over a 19-year period prior to 1950. In a study of 337 peripheral emboli at the Massachusetts General Hospital over a 16-year period ending in 1954, Warren, Linton, and Scannell42 reported an incidence of 9.0 per cent saddle emboli. It is significant that in these series over half of all emboli threatening the viability of the lower extremities lodged at the aortic, iliac or femoral artery bifurcations. In the cases reviewed by Warren and his associates, aortic embolectomy constituted 24 per cent of all the embolectomies performed. The records from 1944 through 1954 at the Presbyterian Hospital in New York disclosed 81 patients with emboli to the major vessels of the lower extremities. Of these, 19 (23.5%) were to the aortic bifurcation. Three additional patients are included in this report. Two were treated at other hospitals and were subsequently studied postmortem at Presbyterian Hospital. The remaining case was operated by one of us (R. A. D.) at another hospital. All patients have been followed until their deaths and those patients still surviving have been followed for five years or longer