Acute aortic occlusion with complications from delayed presentation

A 61-year-old man presented with a 5-day history of bilateral leg pain and 1-day history of shortness of breath. He sought treatment after increased difficulty in breathing. His left leg was cold, blue, and painful; whereas his right leg appeared mottled. Doppler revealed that femoral pulses were absent bilaterally. A cardiopulmonary examination showed faint right-sided rales, tachypnea, and tachycardia. The patient was intubated because of ongoing respiratory failure after not responding to Bilevel Positive Airway Pressure therapy. Computed tomographic angiogram of the chest, abdomen, and pelvis revealed an aortic occlusion just distal to the superior mesenteric artery, occluding the renal and iliac arteries. Laboratory studies revealed severe metabolic acidosis and multiorgan failure. He was made do not resuscitate comfort care only, transferred to hospice, and died 12 hours after admission. Although acute aortic occlusion is rare, it is associated with high morbidity and mortality. This case provides insight into how acute aortic occlusion may present when there is delay in seeking medical care.