Efficacy of Intraoperative Continuous Hemodiafiltration and Modified Controlled Limb Reperfusion in a Case of Acute Abdominal Aortic Occlusion

Abstract

Acute abdominal aortic occlusion (AAAO) is a rare and life threatening disease, and is associated with a high incidence of myonephropathic metabolic syndrome (MNMS). A 77-year-old man was referred our emergency department because of sudden bilateral lower extremity paralysis. Physical examination revealed a pulse deficit in the bilateral lower limbs, as well as motor and sensory disorder of the bilateral lower limbs. Enhanced CT revealed an abdominal aortic occlusion from the bifurcation of the right renal artery to the bilateral iliac arteries. We considered that emergent surgical revascularization was necessary. However, we feared that risk of MNMS after revascularization might be high because ischemia had persisted for 14 hours since onset. Therefore we performed left axillary artery–bilateral femoral artery bypass, intraoperative CHDF (continuous hemodiafiltration) and modified controlled limb reperfusion. Postoperatively, we continued CHDF for improvement from MNMS. Although the patient was at high risk for MNMS, using the above techniques we were able to save his life and legs.