-
Views
-
Cite
Cite
Mattia Cattaneo, Carla Puligheddu, Gabutti Luca, Augusto Gallino, Chronic pararenal aortic and iliac occlusion, European Heart Journal, Volume 39, Issue 47, 14 December 2018, Page 4185, https://doi.org/10.1093/eurheartj/ehy549
- Share Icon Share
Extract
A 76-year old deaf-dumb man known for metabolic syndrome, cerebrovascular disease, worsening renal function, a 40 pack year smoking history, and alcohol abuse was admitted for an uncomplicated head trauma after an accidental fall. Medical history was significant for a IIb stage Fontaine (Rutherford 2 stage) claudication. Physical examination showed neither abdominal bruits nor ischaemic changes of skin and subcutaneous tissues of the lower limbs (LL). There was a bilateral severe reduction of the ankle–brachial index, thus diagnosing significant LL peripheral artery disease.
The patient underwent a computed tomography angiography that disclosed a complete chronic thrombotic occlusion of the pararenal abdominal aorta (AA) and bilateral aortoiliac occlusion including the entire external iliac arteries (Panel A, *). Common femoral arteries were perfused bilaterally by collaterals. Systemic collateral pathways from the abdominal wall (Panel A, red arrows) connected the superior and inferior circulations. Right renal artery was included in the atherothrombotic occlusion with complete occlusion and ipsilateral renal atrophy (Panels C and D, red arrows). Subsequently, to his comorbidities, the alcohol abuse and the fragile social environment, it was decided to pursue a conservative management by best medical therapy. Chronic occlusive disease represents a minority of patients with aortoiliac disease.