Insidious thrombosis of the abdominal aorta.

The clinical manifestations of embolic occlusion of the bifurcation of the abdominal aorta are sufficiently well recognized and oftoo frequent occurrence to require enumeration. Cases previously reported have usually been described under the title of " embolism and thrombosis of the abdominal aorta." In other reports entitled " thrombosis of the abdominal aorta," the descriptions indicate prior embolization, the thrombotic process occurring secondarily to lodgement of a saddle embolus, or developing in a retrograde manner following embolic occlusion of an iliac or femoral artery. The syndrome of massive embolization of the abdominal aorta is a dramatic and sudden event demanding prompt diagnosis and therapy if life and limbs are to be preserved. It is not likely to be overlooked. In contrast, it is not generally recognized that insidious thrombosis of the terminal aorta, not dependent upon prior embolization, may occur. It is probable that the incidence of this condition is greater than the number of published cases would suggest. Elken and Cooper (1949) record that ten examples were encountered by them over the -course of twenty months. The first description of aortic thrombosis is that of Barth, who in 1948 recorded the finding at necropsy of partial occlusion of the abdominal aorta in a woman who died from phthisis. During life there had been no symptoms referable to this lesion. Welch's reference to the problem, as seen by the morbid anatomist, is pertinent. He stated " it is difficult, indeed impossible, from published descriptions . . to determine accurately how many of these cases were referable to embolism and how many to thrombosis." Since 1940 the clinical picture of insidious thrombosis of the terminal aorta has been made clear, largely owing to the communications of Leriche and his associates (1948).