Intraoperative acute aortic obstructive embolism

UNLABELLED: We report a case of acute embolic obstruction of the aorta in a 36-year-old patient undergoing coronary artery bypass surgery. After declamping of the aorta at the end of extracorporeal circulation, blood pressure measured in the femoral artery dropped to 10-20 mmHg. Neither clinical signs of arterial hypotension nor a dysfunction of the arterial line could be observed. Cannulation of the left radial artery revealed a normal systemic blood pressure. After the end of surgery, pale and pulseless lower extremities were observed, suggesting arterial obstruction. A 6 X 3 cm embolus occluding the aortic bifurcation could be extracted with a Fogarty catheter; its origin was presumably an aneurysmatic area of the left ventricle. Surgical manipulation had mobilised the mural thrombus, which caused Leriche's syndrome after aortic declamping and defibrillation of the heart. CONCLUSION: In case of sudden alterations of lower extremity perfusion, anaesthetists and surgeons should consider the rare complication of acute embolic obstruction of the aorta originating from intracardiac thrombotic material. Routine monitoring with transoesophageal echocardiography should thus be considered in patients at risk for intracardiac thrombus formation.