腹主动脉完全闭塞:在老年人中仍然是一个致命的事件。

IF 0.8 Q3 MEDICINE, GENERAL & INTERNAL
Archive of clinical cases Pub Date : 2021-12-29 eCollection Date: 2021-01-01 DOI:10.22551/2021.32.0803.10184
Gonçalo José Pereira Carneiro, Carla Martins
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引用次数: 0

摘要

腹主动脉完全闭塞是一种罕见但具有潜在毁灭性的事件。临床症状通常是突然的,并可能根据主动脉阻塞的程度而变化。相关的发病率和死亡率仍然很高,肢体丧失、急性肾功能衰竭、横纹肌溶解和死亡的发生率很高。我们报告一位患有高血压、高脂血症、贫血和痴呆病史的91岁卧床不起的妇女,因双侧下肢苍白而被送往急诊科。患者一周前因同样的问题和高血压在同一科室就诊,经降压药治疗和短期观察后出院。没有人注意到这些灌注变化,也没有注意到全球的情况。体格检查显示下肢变冷,上肢和下肢血压差明显(踝肱指数0.173),怀疑双侧急性肢体缺血。腹部、盆腔及下肢CT显示胸腹主动脉钙化及重要动脉粥样硬化,腹腔干起始上方有附壁血栓,肾动脉起始下方完全闭塞。经与血管外科讨论,考虑到患者的高龄,已知的合并症和诊断的时机,认为患者不适合进行血运重建术,并采取舒适措施。这一病例突出了及时和正确诊断的重要性,即使在老年人中也是如此,强调他们也受益于二级和三级预防,以防止这种毁灭性的后果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Total occlusion of abdominal aorta: still a deadly event in the very elderly.

Total occlusion of abdominal aorta: still a deadly event in the very elderly.

Total occlusion of abdominal aorta: still a deadly event in the very elderly.

Total occlusion of the abdominal aorta is an uncommon but potentially devastating event. Clinical symptoms are usually sudden and may vary depending on the level of the aortic occlusion. Associated morbidity and mortality remain substantial with high rates of limb loss, acute renal failure, rhabdomyolysis, and death. We report a case of a bedridden 91-year-old woman with history of hypertension, hyperlipidemia, anemia and dementia, carried to the emergency department because of bilateral lower limb pallor. She had been at the same department the week before because of the same problems and high blood pressure (BP), but had been discharged after administration of hypotensive drugs and a short period of observation. No attention was paid to those perfusion alterations, or the global picture at all. The physical examination revealed cooling of the lower limbs and significant BP differential between upper and lower limbs (ankle-brachial index of 0.173), leading to the suspicion of bilateral acute limb ischemia. Abdominal, pelvic and lower limb CT was conducted, revealing calcification and important atheromatosis of the thoracic-abdominal aorta and a mural thrombus beginning above the origin of the celiac trunk, with complete occlusion below the origin of the renal arteries. After discussion with Vascular Surgery Department, given the advanced age, known co-morbidities and the timing of diagnosis, the patient was considered not eligible for revascularization surgery and comfort measures were honored. This case highlights the importance of stablishing a timely and correct diagnosis, even in the very elderly, emphasizing that they too benefit from secondary and tertiary prophylaxis, in order to prevent devastating outcomes as this.

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