Introduction: Acute aortic occlusion (AAO) is rare but frequently fatal due to diagnostic delays. Clinical presentations often mimic more common neurologic, cardiac, or gastrointestinal emergencies. Association with underlying vasculitis, such as Buerger’s disease, is rarely recognized but crucial for early diagnosis.
Description: A 66-year-old female with COPD, Buerger’s disease, recurrent diverticulitis, and recent below-knee amputation presented with altered mental status, severe abdominal pain, and shock, triggering stroke and STEMI alerts. She had severe lactic acidosis, hyperkalemia, and absent femoral pulses. CT angiography demonstrated complete infrarenal aortic occlusion, widespread thromboembolism, severe mesenteric ischemia, and multiorgan infarctions. Despite aggressive supportive care, surgical teams determined she was too unstable for intervention. She rapidly deteriorated andand succumbed to cardiac arrest.
Discussion: A critical and novel element in this presentation was the patient’s known diagnosis of Buerger’s disease (thromboangiitis obliterans), a rare vasculitis classically affecting small-to-medium-sized vessels and primarily associated with peripheral arterial disease and distal limb ischemia. Although large-vessel involvement is exceedingly rare and only scarcely documented in the literature, systemic inflammation, chronic endothelial dysfunction, and enhanced thrombotic risk inherent in Buerger’s disease may predispose patients to catastrophic thromboembolic events involving major arteries.Notably, recent limb amputation, prolonged immobilization, and underlying inflammatory conditions likely heightened this patient’s risk profile, potentially explaining the unusual involvement of the infrarenal aorta and visceral arteries observed in this case. This case underscores the diagnostic pitfalls in Acute aortic occlusion presentations and highlights Buerger’s disease as a potential contributor to rare large-vessel thrombosis. Early suspicion, vascular imaging, and multidisciplinary management are paramount to survival.
