Occlusion of the branches of the abdominal part of the aorta: causes, symptoms, diagnosis, treatment

Various aortic branches can be occluded due to atherosclerosis, fibromuscular dysplasia or other conditions, leading to symptoms of ischemia or infarction.

Diagnosis is established using visualization studies. Treatment involves embolectomy, angioplasty, or (sometimes) surgical bypass surgery.

[1], [2], [3]

Causes of occlusion of the branches of the abdominal aorta

Acute occlusion of the branches of the abdominal part of the aorta may result from embolism, thrombosis of an atherosclerotic altered vessel or bundle. Chronic occlusion develops with atherosclerosis, fibromuscular dysplasia or external compression (for many reasons). Frequent localization of occlusion involves arteries of the organs (eg, superior mesenteric artery, celiac trunk, renal arteries) and aortic bifurcation. Chronic occlusion of the celiac trunk is more common in women for unclear reasons.

[4], [5], [6], [7]

Symptoms of occlusion of the branches of the abdominal aorta

Symptoms (for example, pain, organ failure, necrosis) are the result of ischemia or infarction. Acute occlusion of the mesenteric artery causes intestinal ischemia and a heart attack, resulting in severe abdominal pain ("acute abdomen"). Acute occlusion of the celiac trunk can lead to a spleen or liver infarction. Chronic vascular mesenteric insufficiency rarely causes symptoms if both the superior mesenteric artery and the celiac trunk are not significantly narrowed or not occluded, since there is extensive collateral circulation between the major arterial trunks. Signs of chronic circulatory failure in the mesenteric artery usually appear after ingestion (like intestinal angina), because digestion requires increased mesenteric blood flow. The pain begins approximately 30 minutes or 1 hour after meals and has a persistent, pronounced character, localized around the navel (possibly reducing it when taking nitroglycerin under the tongue). Patients begin to fear eating, often there is a loss of body weight (up to critical). Sometimes malabsorption develops, contributing to the loss of body weight. There may be rumbling in the abdomen, nausea, vomiting, diarrhea or constipation, dark stools.

Acute occlusion due to embolism in the renal artery causes sudden pain in one half of the body, followed by hematuria. Chronic occlusion may be asymptomatic or lead to the emergence of hypertension, the emergence of its resistance to treatment and other complications of renal failure.

Acute occlusion of the bifurcation of the aorta or distal branches can cause sudden pain at rest, pale skin and mucous membranes, paralysis, lack of peripheral pulse and cold extremities. Chronic occlusion can lead to intermittent claudication (in the legs and buttocks) and erectile dysfunction (Lerish syndrome). The femoral pulse is absent. Lack of a limb is possible.

Diagnosis and treatment of occlusion of the branches of the abdominal aorta

Diagnosis is based primarily on anamnesis and physical examination. Confirm the diagnosis with two-dimensional ultrasound, CTA, MRA or traditional angiography. Acute occlusion is an urgent surgical condition requiring embollectomy or percutaneous intravascular angioplasty (PTCA) with or without stenting. Chronic occlusion, if it causes clinical symptoms, may require surgical intervention or angioplasty. It is necessary to exclude risk factors and antiplatelet drugs.

Acute occlusion of the mesenteric artery (for example, the superior mesenteric artery) causes significant morbidity and mortality, requires rapid prosthetics of the artery. The prognosis is unfavorable if the intestinal blood supply is not restored within 4-6 hours.

With chronic occlusion of the superior mesenteric artery and celiac trunk, nitroglycerin can temporarily reduce manifestations. If the symptoms are severe, surgical shunting of the aorta to the organ arteries is usually used, distal to the occlusion site, which usually leads to the restoration of blood supply. The long-term effect exceeds 90%. In some patients (especially in the older age group where there is a high risk of surgical intervention), revascularization with or without nerve stenting can be successful. Perhaps the rapid disappearance of clinical symptoms with recovery of body weight.

Acute occlusion of the renal artery - an indication for embobectomy, sometimes you can perform NDA. Initial treatment of chronic occlusion includes antihypertensive drugs. If the blood pressure is not corrected or the kidney function worsens, NDA is undertaken with stenting. If NDA can not be performed, open surgical anastomosis or embobectomy can improve blood flow.

Occlusion of aortic bifurcation is an indication for urgent embollectomy, usually performed through the femoral artery. If chronic occlusion of the aortic bifurcation causes lameness, aorto-ileal or aortoscopic bypass surgery with a surgical bypass of the obstruction can be performed. NDA is an alternative for some patients.

[8], [9]