背景:急性主动脉闭塞(AAO)是一种罕见但严重的疾病,与显着的发病率和死亡率相关。
目的:这篇综述提供了对AAO的急诊医学评估,包括介绍,评估,和基于当前证据的急诊科(ED)管理。
结论:AAO是指由于血栓形成或栓塞导致的主动脉血流阻塞。这种情况主要影响60-70岁的老年人心血管合并症,最常见于急性肢体缺血的体征和症状。虽然胃肠道,肾脏,脊髓可能会受到影响。第一线成像模式包括胸部的计算机断层扫描血管造影,腹部,还有骨盆.ED复苏管理包括避免极端的血压或心率,维持正常的氧饱和度和正常血容量状态,肝素抗凝,疼痛控制。建议紧急咨询血管外科专家,以建立通过血管内或开放技术恢复缺血组织灌注的计划。受影响人群中存在的基线合并症以及缺血和再灌注损伤的高发生率使AAO患者在手术治疗后立即和延迟地处于并发症的高风险中。
结论:了解AAO可以帮助急诊临床医生诊断和治疗这种罕见但破坏性疾病。
Acute aortic occlusion (AAO) is a rare but serious condition associated with significant morbidity and mortality.
This review provides an emergency medicine focused evaluation of AAO, including presentation, assessment, and emergency department (ED) management based on current evidence.
AAO refers to obstruction of blood flow through the aorta due to either thrombosis or embolism. This condition primarily affects older adults ages 60-70 with cardiovascular comorbidities and most commonly presents with signs and symptoms of acute limb ischemia, though the gastrointestinal tract, kidneys, and spinal cord may be affected. The first line imaging modality includes computed tomography angiography of the chest, abdomen, and pelvis. ED resuscitative management consists of avoiding extremes of blood pressure or heart rate, maintaining normal oxygen saturation and euvolemic status, anticoagulation with heparin, and pain control. Emergent consultation with the vascular surgery specialist is recommended to establish a plan for restoration of perfusion to ischemic tissues via endovascular or open techniques. High rates of baseline comorbidities present in the affected population as well as ischemic and reperfusion injuries place AAO patients at high risk for complications in an immediate and delayed fashion after surgical management.
An understanding of AAO can assist emergency clinicians in diagnosing and managing this rare but devastating disease.