BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts p...BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts patient outcomes.AIM To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 patients.METHODS We used the national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with CKD stage 1-4.RESULTS Out of 24758 who underwent TAVR and had CKD,7892(32.4%)patients were readmitted within 90 days,and had higher adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with longer length of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive heart failure(CHF).CONCLUSION Most common causes of readmission included CHF(18.0%),sepsis,and complete atrioventricular block.Controlling readmission predictors with very close followup is warranted to prevent such high rate of readmission.展开更多
Coronary ostial stenosis after surgical aortic valve replacement (SAVR) is a rare but potentially fatal complication. Surgeons must have a high level of vigilance regarding the presentation of acute myocardial ischemi...Coronary ostial stenosis after surgical aortic valve replacement (SAVR) is a rare but potentially fatal complication. Surgeons must have a high level of vigilance regarding the presentation of acute myocardial ischemia, arrhythmia, and heart failure after AVR. According to most reports, this event can be time-dependent divided into two groups;early acute phase that mostly happens intraoperative during weaning of CPB or in early ICU stay, and late presentation usually appears 1 - 6 months post surgery. Here, we describe an unusual subacute presentation of right coronary ostial stenosis 12 days after SAVR, which was treated successfully with redo beating heart coronary artery bypass grafting (CABG).展开更多
Heart diseases remain the top threat to human health,and the treatment of heart diseases changes with each passing day.Convincing evidence shows that three-dimensional(3D)printing allows for a more precise understandi...Heart diseases remain the top threat to human health,and the treatment of heart diseases changes with each passing day.Convincing evidence shows that three-dimensional(3D)printing allows for a more precise understanding of the complex anatomy associated with various heart diseases.In addition,3D-printed models of cardiac diseases may serve as effective educational tools and for hands-on simulation of surgical interventions.We introduce examples of the clinical applications of different types of 3D printing based on specific cases and clinical application scenarios of 3D printing in treating heart diseases.We also discuss the limitations and clinically unmet needs of 3D printing in this context.展开更多
AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with I...AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, Pub Med and Psyc INFO, we searched full manuscripts in English and published until September 1, 2014. RESULTS We found sixteen studies exploring psychological issues in patients with IE(six studies) and in TAD(ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE(four papers) and in TAD(eight papers). Depression and anxiety were analyzed in TAD only(five papers). Post-traumatic stress disorder was assessed in IE(one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ. CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.展开更多
Except for the standard aortic valve replacement,no effective medical treatment is available to prevent or delay calcific aortic valve disease(CAVD)progression.Recently,macrophages and high-mobility group box 1(HMGB1)...Except for the standard aortic valve replacement,no effective medical treatment is available to prevent or delay calcific aortic valve disease(CAVD)progression.Recently,macrophages and high-mobility group box 1(HMGB1)are the most intriguing candidates in various inflammatory disorders.However,the association between serum HMGB1,CAVD,and macrophage polarization remains unclear.Therefore,we examined whether the level of serum HMGB1 is clinically associated with aortic valve calcification and whether HMGB1 treatment can promote macrophage differentiation toward M1 or M2 phenotype.This experimental study included 19 CAVD patients and 20 healthy controls whose serum HMGB1 levels were examined by ELISA assay.THP-1 macrophage polarization system was established to test the polarization capability of HMGB1 treatment.The results showed that serum levels of HMGB1 were significantly reduced in patients with CAVD.HMGB1 treatment promoted M2 macrophage polarization but not M1 phenotype with increased IL-10 expression and reduced inducible nitric oxide synthase(iNOS)expression.Our findings suggest that serum HMGB1 is negatively associated with the development of aortic valve calcification,and HMGB1 treatment may facilitate M2 macrophage polarization for reducing aortic valve calcification.展开更多
Objective: To evaluate the clinical application of multi-slice spiral CT angiography(MSCTA) in the assessment of abdominal aortic disease. Methods: Fifty-four patients underwent multi-slice spiral CT angiography o...Objective: To evaluate the clinical application of multi-slice spiral CT angiography(MSCTA) in the assessment of abdominal aortic disease. Methods: Fifty-four patients underwent multi-slice spiral CT angiography of abdomen. Contrast agent (Omnipaque 300 I g/L) 1.5 ml/kg was injected and the injection rate was 3 ml/s. The delay time was determined by bolus tracking technique, Tll level abdominal aorta was set as the target vessel and the threshold was 180-200Hu, slice width was 3mm and with a pitch of 4-6. Original data were transferred to working-station to perform functional reconstruction. Results: Ten cases were normal, twenty-eight cases were abdominal aortic aneurysms, five abdominal aortic dissecting aneurysms (Debakay type Ⅲ) and eleven aortic sclerosis. SSD showed the body of aneurysm and the relationship between aneurysm and adjacent blood vessel, MIP better displayed calcification of blood vessel wall and condition of the stent, MPR demonstrated true and false lumen, rapture site of abdominal aorta intima and mural thrombus. Conelusion: MSCTA axial and reconstruction image can show the extent of abdominal aortic disease and the relationship with adjacent blood vessels. It is a safe, simple and non-invasive examination method.展开更多
Form 2008 to 2009, four patients with complex thoracic aortic disease, including aortic aneurysms and dissections, were successfully treated in our department with a new treatment approach:hybrid procedure.Combined op...Form 2008 to 2009, four patients with complex thoracic aortic disease, including aortic aneurysms and dissections, were successfully treated in our department with a new treatment approach:hybrid procedure.Combined open surgery and endovascular repair were performed in these patients without deep hypothermia or circulatory arrest.Compared to those who underwent traditional open surgery in the same period, time of mechanical ventilation and ICU stay was decreased in these four patients.All of them were discharged soon after operation without postoperative complications or death.The result suggests that this new approach could be an option for thoracic aortic disease, but long-term and large-population studies are still required to demonstrate the safety and validity.展开更多
BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Pote...BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Potential novel predictors of post-TAVR PPM,like QRS duration,QTc prolongation,and supraventricular arrhythmias,have been poorly studied.AIM To evaluate the effects of baseline nonspecific interventricular conduction delay and supraventricular arrhythmia on post-TAVR PPM requirement and determine the impact of PPM implantation on clinical outcomes.METHODS RESULTS Out of the 357 patients that met inclusion criteria,the mean age was 80 years,188(52.7%)were male,and 57(16%)had a PPM implantation.Baseline demographics,valve type,and cardiovascular risk factors were similar except for type II diabetes mellitus(DM),which was more prevalent in the PPM cohort(59.6%vs 40.7%;P=0.009).The PPM cohort had a significantly higher rate of pre-procedure right bundle branch block,prolonged QRS>120 ms,prolonged QTc>470 ms,and supraventricular arrhythmias.There was a consistently significant increase in the odds ratio(OR)of PPM implantation for every 20 ms increase in the QRS duration above 100 ms:QRS 101-120[OR:2.44;confidence intervals(CI):1.14-5.25;P=0.022],QRS 121-140(OR:3.25;CI:1.32-7.98;P=0.010),QRS 141-160(OR:6.98;CI:3.10-15.61;P<0.001).After model adjustment for baseline risk factors,the OR remained significant for type II DM(aOR:2.16;CI:1.18-3.94;P=0.012),QRS>120(aOR:2.18;CI:1.02-4.66;P=0.045)and marginally significant for supraventricular arrhythmias(aOR:1.82;CI:0.97-3.42;P=0.062).The PPM cohort had a higher adjusted OR of heart failure(HF)hospitalization(aOR:2.2;CI:1.1-4.3;P=0.022)and nonfatal myocardial infarction(MI)(aOR:3.9;CI:1.1-14;P=0.031)without any difference in mortality(aOR:1.1;CI:0.5-2.7;P=0.796)at one year.CONCLUSION Pre-TAVR type II DM and QRS duration>120,regardless of the presence of bundle branch blocks,are predictors of post-TAVR PPM.At 1-year post-TAVR,patients with PPM have higher odds of HF hospitalization and MI.展开更多
The case presented here offers us an opportunity to discuss an increasingly commonly confronted clinical challenge.Two issues are raised:how best to manage the patient’s valvular heart disease,including both the indi...The case presented here offers us an opportunity to discuss an increasingly commonly confronted clinical challenge.Two issues are raised:how best to manage the patient’s valvular heart disease,including both the indications for surgical intervention and the prosthetic options,and how best to manage his aortic dilatation.Let us take them one at a time.The patient has severe aortic regurgitation but a normal ejection fraction.Although we do not have his ventricular dimensions,he has a class I indication for intervention given his symptoms.展开更多
Cardiac valve calcification is a common disease,especially among the elderly.Calcification can affect valve function and cause heart failure and sudden death(Adler et al.,2002).Aortic valve calcification is alsorelate...Cardiac valve calcification is a common disease,especially among the elderly.Calcification can affect valve function and cause heart failure and sudden death(Adler et al.,2002).Aortic valve calcification is alsorelated to arteriosclerosis and coronary heart disease(Rashedi et al.,2015).However,the origin of valve calcification is still unclear.This study characterized the展开更多
Non-A non-B aortic dissection(AAD)is an infrequently documented condition,comprising of only a small proportion of all AADs.The unique anatomy of the aortic arch and the failure of the existing classifications to adeq...Non-A non-B aortic dissection(AAD)is an infrequently documented condition,comprising of only a small proportion of all AADs.The unique anatomy of the aortic arch and the failure of the existing classifications to adequately define individuals with non-A non-B AAD,have led to an ongoing controversy around the topic.It seems that the clinical progression of acute non-A non-B AAD diverges from the typical type A and B dissections,frequently leading to serious complications and thus mandating early intervention.Currently,the available treatment methods in the surgical armamentarium are conventional open,endovascular techniques and combined hybrid methods.The optimum approach is tailored in every individual case and may be determined by the dissection’s location,extent,the aortic diameter,the associated complications and the patient’s status.The management of non-A non-B dissections still remains challenging and a unanimous consensus defining the gold standard treatment has yet to be reached.In an attempt to provide further insight into this perplexing entity,we performed a minireview of the literature,aiming to elucidate the epidemiology,clinical course and the optimal treatment modality.展开更多
Acute Aortic Occlusion (AAO) is a rare, life-threatening event so far described mainly in small-scale series. The most common causes of AAO are large saddle emboli to the aortic bifurcation, in-situ thrombosis of an a...Acute Aortic Occlusion (AAO) is a rare, life-threatening event so far described mainly in small-scale series. The most common causes of AAO are large saddle emboli to the aortic bifurcation, in-situ thrombosis of an atherosclerotic aorta, and occlusion of previous surgical reconstruction. We present the case of a 52-year-old female with rheumatic heart disease, ischemic cardiomyopathy with restricted left ventricular function, atrial fibrillation, and previous cardio-embolic stroke, who was brought to the Emergency Department (ED) with sudden-onset dyspnea and lower backache radiating to both the legs. On arrival at the ED, the patient was electively intubated and mechanically ventilated in view of hypoxia and altered mental status, attributed to respiratory failure secondary to acute cardiogenic pulmonary oedema. The secondary survey revealed absence of bilateral femoral and popliteal artery pulsations. A computed tomography (CT) aortogram showed a complete lumen occlusion thrombus in the infra-renal region of the abdominal aorta at the level of L3-L4 lumbar vertebrae. An emergency embolectomy was performed successfully, following which the patient was started on heparin infusion and managed in the Intensive Care Unit (ICU). In the ICU, she suffered a torsade-cardiac arrest, with return of spontaneous circulation (ROSC) following rapid defibrillation. She was extubated on Day 3. Three weeks later, she was discharged from the hospital. At the time of discharge, she had developed ischemic lumbosacral radiculoplexus neuropathy, for which neuro-rehabilitation was advised. In our case report, we would like to highlight the following key points: 1) The importance of a detailed secondary survey in the Emergency Department (ED). 2) An inter-disciplinary approach to a complex syndrome that ensures the highest probability of a good outcome. .展开更多
文摘BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts patient outcomes.AIM To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 patients.METHODS We used the national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with CKD stage 1-4.RESULTS Out of 24758 who underwent TAVR and had CKD,7892(32.4%)patients were readmitted within 90 days,and had higher adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with longer length of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive heart failure(CHF).CONCLUSION Most common causes of readmission included CHF(18.0%),sepsis,and complete atrioventricular block.Controlling readmission predictors with very close followup is warranted to prevent such high rate of readmission.
文摘Coronary ostial stenosis after surgical aortic valve replacement (SAVR) is a rare but potentially fatal complication. Surgeons must have a high level of vigilance regarding the presentation of acute myocardial ischemia, arrhythmia, and heart failure after AVR. According to most reports, this event can be time-dependent divided into two groups;early acute phase that mostly happens intraoperative during weaning of CPB or in early ICU stay, and late presentation usually appears 1 - 6 months post surgery. Here, we describe an unusual subacute presentation of right coronary ostial stenosis 12 days after SAVR, which was treated successfully with redo beating heart coronary artery bypass grafting (CABG).
基金This study was supported by the National key R&D plan(No.2020YFC2008100)the Science and Technology Innovation Team Project of the Shaanxi Innovation Capability Support Plan(No.S2020-ZC-TD-0029)the Science Foundation for Distinguished Young Scholars of Shaanxi Natural Science Basic Research Program(No.S2018-JC-JQ-0094)。
文摘Heart diseases remain the top threat to human health,and the treatment of heart diseases changes with each passing day.Convincing evidence shows that three-dimensional(3D)printing allows for a more precise understanding of the complex anatomy associated with various heart diseases.In addition,3D-printed models of cardiac diseases may serve as effective educational tools and for hands-on simulation of surgical interventions.We introduce examples of the clinical applications of different types of 3D printing based on specific cases and clinical application scenarios of 3D printing in treating heart diseases.We also discuss the limitations and clinically unmet needs of 3D printing in this context.
文摘AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, Pub Med and Psyc INFO, we searched full manuscripts in English and published until September 1, 2014. RESULTS We found sixteen studies exploring psychological issues in patients with IE(six studies) and in TAD(ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE(four papers) and in TAD(eight papers). Depression and anxiety were analyzed in TAD only(five papers). Post-traumatic stress disorder was assessed in IE(one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ. CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.
文摘Except for the standard aortic valve replacement,no effective medical treatment is available to prevent or delay calcific aortic valve disease(CAVD)progression.Recently,macrophages and high-mobility group box 1(HMGB1)are the most intriguing candidates in various inflammatory disorders.However,the association between serum HMGB1,CAVD,and macrophage polarization remains unclear.Therefore,we examined whether the level of serum HMGB1 is clinically associated with aortic valve calcification and whether HMGB1 treatment can promote macrophage differentiation toward M1 or M2 phenotype.This experimental study included 19 CAVD patients and 20 healthy controls whose serum HMGB1 levels were examined by ELISA assay.THP-1 macrophage polarization system was established to test the polarization capability of HMGB1 treatment.The results showed that serum levels of HMGB1 were significantly reduced in patients with CAVD.HMGB1 treatment promoted M2 macrophage polarization but not M1 phenotype with increased IL-10 expression and reduced inducible nitric oxide synthase(iNOS)expression.Our findings suggest that serum HMGB1 is negatively associated with the development of aortic valve calcification,and HMGB1 treatment may facilitate M2 macrophage polarization for reducing aortic valve calcification.
文摘Objective: To evaluate the clinical application of multi-slice spiral CT angiography(MSCTA) in the assessment of abdominal aortic disease. Methods: Fifty-four patients underwent multi-slice spiral CT angiography of abdomen. Contrast agent (Omnipaque 300 I g/L) 1.5 ml/kg was injected and the injection rate was 3 ml/s. The delay time was determined by bolus tracking technique, Tll level abdominal aorta was set as the target vessel and the threshold was 180-200Hu, slice width was 3mm and with a pitch of 4-6. Original data were transferred to working-station to perform functional reconstruction. Results: Ten cases were normal, twenty-eight cases were abdominal aortic aneurysms, five abdominal aortic dissecting aneurysms (Debakay type Ⅲ) and eleven aortic sclerosis. SSD showed the body of aneurysm and the relationship between aneurysm and adjacent blood vessel, MIP better displayed calcification of blood vessel wall and condition of the stent, MPR demonstrated true and false lumen, rapture site of abdominal aorta intima and mural thrombus. Conelusion: MSCTA axial and reconstruction image can show the extent of abdominal aortic disease and the relationship with adjacent blood vessels. It is a safe, simple and non-invasive examination method.
基金supported by a grant form the Natural Sciences Foundation of Hubei Province,China (No.2008-CDB 207)
文摘Form 2008 to 2009, four patients with complex thoracic aortic disease, including aortic aneurysms and dissections, were successfully treated in our department with a new treatment approach:hybrid procedure.Combined open surgery and endovascular repair were performed in these patients without deep hypothermia or circulatory arrest.Compared to those who underwent traditional open surgery in the same period, time of mechanical ventilation and ICU stay was decreased in these four patients.All of them were discharged soon after operation without postoperative complications or death.The result suggests that this new approach could be an option for thoracic aortic disease, but long-term and large-population studies are still required to demonstrate the safety and validity.
文摘BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Potential novel predictors of post-TAVR PPM,like QRS duration,QTc prolongation,and supraventricular arrhythmias,have been poorly studied.AIM To evaluate the effects of baseline nonspecific interventricular conduction delay and supraventricular arrhythmia on post-TAVR PPM requirement and determine the impact of PPM implantation on clinical outcomes.METHODS RESULTS Out of the 357 patients that met inclusion criteria,the mean age was 80 years,188(52.7%)were male,and 57(16%)had a PPM implantation.Baseline demographics,valve type,and cardiovascular risk factors were similar except for type II diabetes mellitus(DM),which was more prevalent in the PPM cohort(59.6%vs 40.7%;P=0.009).The PPM cohort had a significantly higher rate of pre-procedure right bundle branch block,prolonged QRS>120 ms,prolonged QTc>470 ms,and supraventricular arrhythmias.There was a consistently significant increase in the odds ratio(OR)of PPM implantation for every 20 ms increase in the QRS duration above 100 ms:QRS 101-120[OR:2.44;confidence intervals(CI):1.14-5.25;P=0.022],QRS 121-140(OR:3.25;CI:1.32-7.98;P=0.010),QRS 141-160(OR:6.98;CI:3.10-15.61;P<0.001).After model adjustment for baseline risk factors,the OR remained significant for type II DM(aOR:2.16;CI:1.18-3.94;P=0.012),QRS>120(aOR:2.18;CI:1.02-4.66;P=0.045)and marginally significant for supraventricular arrhythmias(aOR:1.82;CI:0.97-3.42;P=0.062).The PPM cohort had a higher adjusted OR of heart failure(HF)hospitalization(aOR:2.2;CI:1.1-4.3;P=0.022)and nonfatal myocardial infarction(MI)(aOR:3.9;CI:1.1-14;P=0.031)without any difference in mortality(aOR:1.1;CI:0.5-2.7;P=0.796)at one year.CONCLUSION Pre-TAVR type II DM and QRS duration>120,regardless of the presence of bundle branch blocks,are predictors of post-TAVR PPM.At 1-year post-TAVR,patients with PPM have higher odds of HF hospitalization and MI.
文摘The case presented here offers us an opportunity to discuss an increasingly commonly confronted clinical challenge.Two issues are raised:how best to manage the patient’s valvular heart disease,including both the indications for surgical intervention and the prosthetic options,and how best to manage his aortic dilatation.Let us take them one at a time.The patient has severe aortic regurgitation but a normal ejection fraction.Although we do not have his ventricular dimensions,he has a class I indication for intervention given his symptoms.
基金supported by the National Natural Science Foundation of China(Grant NO.40972210,41272048)
文摘Cardiac valve calcification is a common disease,especially among the elderly.Calcification can affect valve function and cause heart failure and sudden death(Adler et al.,2002).Aortic valve calcification is alsorelated to arteriosclerosis and coronary heart disease(Rashedi et al.,2015).However,the origin of valve calcification is still unclear.This study characterized the
文摘Non-A non-B aortic dissection(AAD)is an infrequently documented condition,comprising of only a small proportion of all AADs.The unique anatomy of the aortic arch and the failure of the existing classifications to adequately define individuals with non-A non-B AAD,have led to an ongoing controversy around the topic.It seems that the clinical progression of acute non-A non-B AAD diverges from the typical type A and B dissections,frequently leading to serious complications and thus mandating early intervention.Currently,the available treatment methods in the surgical armamentarium are conventional open,endovascular techniques and combined hybrid methods.The optimum approach is tailored in every individual case and may be determined by the dissection’s location,extent,the aortic diameter,the associated complications and the patient’s status.The management of non-A non-B dissections still remains challenging and a unanimous consensus defining the gold standard treatment has yet to be reached.In an attempt to provide further insight into this perplexing entity,we performed a minireview of the literature,aiming to elucidate the epidemiology,clinical course and the optimal treatment modality.
文摘Acute Aortic Occlusion (AAO) is a rare, life-threatening event so far described mainly in small-scale series. The most common causes of AAO are large saddle emboli to the aortic bifurcation, in-situ thrombosis of an atherosclerotic aorta, and occlusion of previous surgical reconstruction. We present the case of a 52-year-old female with rheumatic heart disease, ischemic cardiomyopathy with restricted left ventricular function, atrial fibrillation, and previous cardio-embolic stroke, who was brought to the Emergency Department (ED) with sudden-onset dyspnea and lower backache radiating to both the legs. On arrival at the ED, the patient was electively intubated and mechanically ventilated in view of hypoxia and altered mental status, attributed to respiratory failure secondary to acute cardiogenic pulmonary oedema. The secondary survey revealed absence of bilateral femoral and popliteal artery pulsations. A computed tomography (CT) aortogram showed a complete lumen occlusion thrombus in the infra-renal region of the abdominal aorta at the level of L3-L4 lumbar vertebrae. An emergency embolectomy was performed successfully, following which the patient was started on heparin infusion and managed in the Intensive Care Unit (ICU). In the ICU, she suffered a torsade-cardiac arrest, with return of spontaneous circulation (ROSC) following rapid defibrillation. She was extubated on Day 3. Three weeks later, she was discharged from the hospital. At the time of discharge, she had developed ischemic lumbosacral radiculoplexus neuropathy, for which neuro-rehabilitation was advised. In our case report, we would like to highlight the following key points: 1) The importance of a detailed secondary survey in the Emergency Department (ED). 2) An inter-disciplinary approach to a complex syndrome that ensures the highest probability of a good outcome. .