Morphology of the human aorta and age-related changes: anatomical facts

Pornhatai Komutrattananont,Pasuk Mahakkanukrauh,Srijit Das 대한해부학회 2019 Anatomy & Cell Biology Vol.52 No.2

Aorta is the largest artery in the human body. Its starting point is the aortic orifice of the aortic valve and it terminates at the level of the fourth lumbar vertebra. The main function of the aorta is to transport oxygenated blood to supply all the organs and cells. With advancing age, the structure and hence the function show progressive changes. Various changes in the aortic morphology include the luminal diameter of aorta, whole length of the aorta, thickness, the microstructural components also change, and these include collagen, elastin and smooth muscle cells. In addition, the dimensions of all segments of the aorta increase with age in both sexes. Since age is a major risk factor for degenerative change and diseases affecting the aorta, understanding the detailed anatomy of the aorta may provide essential information concerning the age-associated process of the aorta. Knowledge of the morphological changes in the aorta is also important for future clinical therapies pertaining to aortic disease. Additionally, the information regarding the structural changes with age may be applied for age determination. This review describes the overview of the anatomy of the aorta, age related changes in the morphology of the aorta and aortic diseases.

Review Article : Bupivacaine-induced Vasodilation Is Mediated by Decreased Calcium Sensitization in Isolated Endothelium-denuded Rat Aortas Precontracted with Phenylephrine

( Seong Ho Ok ),( Sung Il Bae ),( Seong Chun Kwon ),( Jung Chul Park ),( Woo Chan Kim ),( Kyeong Eon Park ),( Il Woo Shin ),( Heon Keun Lee ),( Young Kyun Chung ),( Mun Jeoung Choi ),( Ju Tae Sohn ) 대한통증학회 2014 The Korean Journal of Pain Vol.27 No.3

Background: A toxic dose of bupivacaine produces vasodilation in isolated aortas. The goal of this in vitro study was to investigate the cellular mechanism associated with bupivacaine-induced vasodilation in isolated endotheliumdenuded rat aortas precontracted with phenylephrine. Methods: Isolated endothelium-denuded rat aortas were suspended for isometric tension recordings. The effects of nifedipine, verapamil, iberiotoxin, 4-aminopyridine, barium chloride, and glibenclamide on bupivacaine concentration-response curves were assessed in endothelium-denuded aortas precontracted with phenylephrine. The effect of phenylephrine and KCl used for precontraction on bupivacaine-induced concentration-response curves was assessed. The effects of verapamil on phenylephrine concentration-response curves were assessed. The effects of bupivacaine on the intracellular calcium concentration ([Ca2+] i) and tension in aortas precontracted with phenylephrine were measured simultaneously with the acetoxymethyl ester of a fura-2-loaded aortic strip. Results: Pretreatment with potassium channel inhibitors had no effect on bupivacaine-induced relaxation in the endothelium-denuded aortas precontracted with phenylephrine, whereas verapamil or nifedipine attenuated bupivacaine-induced relaxation. The magnitude of the bupivacaine-induced relaxation was enhanced in the 100 mM KCl-induced precontracted aortas compared with the phenylephrine-induced precontracted aortas. Verapamil attenuated the phenylephrine-induced contraction. The magnitude of the bupivacaine-induced relaxation was higher than that of the bupivacaine-induced [Ca2+] i decrease in the aortas precontracted with phenylephrine. Conclusions: Taken together, these results suggest that toxic-dose bupivacaine-induced vasodilation appears to be mediated by decreased calcium sensitization in endothelium-denuded aortas precontracted with phenylephrine. In addition, potassium channel inhibitors had no effect on bupivacaine-induced relaxation. Toxic-dose bupivacaine- induced vasodilation may be partially associated with the inhibitory effect of voltage-operated calcium channels.

다중검출 전산화 단층촬영을 이용하여 측정한 흉부대동맥의 직경

이건,임창영,이헌재 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.1

Background: Background: Computed tomography (CT) is the main tool for detecting abnormalities of the thoracic aorta, but conventional CT only shows the cross-sectional images. These CT images have some limitations fo accuratly measuring the thoracic aortic diameters at various levels. Multidetector computed tomography (MDCT) overcomes these limitations. We measured the thoracic aortic diameter perpendicular to the loop-shaped thoracic aortic course and this was studied in relation to age, gender, height, weight, the body surface area, the body mass index and the presence of hypertension. Material and Method: Thirty hundred thirty one patients (males: 141 patients and females: 190 patients) who had no abnormalities of the thoracic aorta were investigated using MDCT aortography. They were divided into three age categories: 20∼39 years old, 40∼59 years old and over age 60. The image was reformed with multiplanar reconstruction and the diameter of the aorta was measured perpendicular to the aortic course at 5 anatomic segments. Level A was the mid-ascending aorta, level B was the distal ascending aorta, level C was the aortic arch, level D was the aortic isthmus and level E was the mid-descending aorta. Result: The mean age was 49.5 years old for males and 54.9 years old for females (p<0.05). The mean diameter of the thoracic aorta at level A was 31.1 mm, that at level B was 30.2 mm, that at level C was 26.5 mm, that at level D was 24.0 mm and that at level E was 22.6 mm. The diameters at all the levels were gradually increased with age. Hypertensive patients had larger diameters than did the non-hypertensive population. There was a positive correlation between the ascending aortic diameter (levels A&B) and height and the body surface area, but there were no statistical differences at the aortic arch (level C) and the descending aorta (levels D&E). There were no statistical differences of the weight and body mass index at all levels. Conclusion: The diameters of the thoracic aortas were directly correlated with gender, age and hypertension. Height and the body surface area were only correlated with the ascending aorta. Weight and the body mass index have no statistical difference at all levels. We measured the age related thoracic aortic diameters and the upper normal limits and we provide this data as reference values for the thoracic aortic diameter in the Korean population. 배경: 전산화 단층촬영은 흉부대동맥의 이상소견을 진단하는데 매우 중요한 수단이다. 그러나 재래의 전산화 단층좔영은 단면적인 영상만을 볼 수 있어 여러 부위의 대동맥 직경을 측정하기에는 한계가 있었다. 다중검출 전산화 단층촬영은 이러한 한계를 극복할 수 있는 진단기기로 이를 이용하여 곡선으로 된 흉부대동맥의 직경을 주행방향과 직각으로 측정하여 연령, 성별, 키와 몸무게, 체표면적과 체질량지수, 고혈압과의 관계를 알아보고자 하였다. 대상 및 방법: 다중검출 전산화 단층촬영 장비를 이용하여 대동맥 조영술을 시행한 환자 중 특별한 대동맥 질환이 없는 것으로 판독된 환자 331명을 대상으로 하였으며, 남자가 141명이고 여자가 190명이었다. 이들을 연령별로 20∼39세, 40∼59세, 60세 이상으로 분류하였다. 대동맥의 직경은 다면상으로 재구성한 단면에서 대동맥 주행방향과 직각이 되도록 측정하였으며 상행대동맥의 중간(level A), 원위부 상행대동맥(level B), 대동맥궁(level C), 대동맥 협부(level D), 하행대동맥의 중간(level E)의 다섯 군데에서 측정하였다. 결과: 대상환자의 평균연령은 남자가 49.5세이고 여자가 54.9세였다. 대동맥의 평균직경은 level A가 31.1 mm, level B가30.2 mm, level C가 26.5 mm, level D가 24.0 mm, level E가 22.6 mm였다. 대동맥의 직경은 나이에 비례해서 증가하는 양상을 보였으며 고혈압 환자가 정상인보다 대동맥의 직경이 크게 나타났다. 키와 체표면적에 따른 차이는 상행대동맥에서 유의하게 나타났고 대동맥궁과 하행대동맥은 유의한 차이가 없었다. 체중과 체질량지수는 모든 부위에서 통계적 유의성이 없었다. 결론: 흉부대동맥의 직경은 성별과 나이, 고혈압에 통계적으로 유의한 차이가 있었고 키와 체표면적은 상행대동맥에만 차이를 보였고 하행대동맥에는 차이가 없었다. 그리고 체중과 체질량지수는 모든 부위에서 통계적 유의성이 없었다. 본 연구에서는 고혈압이 없는 정상인에서 연령별 대동맥 직경의 표준값과 정상한계값을 측정하였고 이를 한국인의 흉부대동맥 직경의 참고자료로 제시하고자 한다.

Bupivacaine-induced Vasodilation Is Mediated by Decreased Calcium Sensitization in Isolated Endothelium-denuded Rat Aortas Precontracted with Phenylephrine

Ok, Seong Ho,Bae, Sung Il,Kwon, Seong Chun,Park, Jung Chul,Kim, Woo Chan,Park, Kyeong Eon,Shin, Il Woo,Lee, Heon Keun,Chung, Young Kyun,Choi, Mun Jeoung,Sohn, Ju Tae The Korean Pain Society 2014 The Korean Journal of Pain Vol.27 No.3

Background: A toxic dose of bupivacaine produces vasodilation in isolated aortas. The goal of this in vitro study was to investigate the cellular mechanism associated with bupivacaine-induced vasodilation in isolated endothelium-denuded rat aortas precontracted with phenylephrine. Methods: Isolated endothelium-denuded rat aortas were suspended for isometric tension recordings. The effects of nifedipine, verapamil, iberiotoxin, 4-aminopyridine, barium chloride, and glibenclamide on bupivacaine concentration-response curves were assessed in endothelium-denuded aortas precontracted with phenylephrine. The effect of phenylephrine and KCl used for precontraction on bupivacaine-induced concentration-response curves was assessed. The effects of verapamil on phenylephrine concentration-response curves were assessed. The effects of bupivacaine on the intracellular calcium concentration ($[Ca^{2+}]_i$) and tension in aortas precontracted with phenylephrine were measured simultaneously with the acetoxymethyl ester of a fura-2-loaded aortic strip. Results: Pretreatment with potassium channel inhibitors had no effect on bupivacaine-induced relaxation in the endothelium-denuded aortas precontracted with phenylephrine, whereas verapamil or nifedipine attenuated bupivacaine-induced relaxation. The magnitude of the bupivacaine-induced relaxation was enhanced in the 100mM KCl-induced precontracted aortas compared with the phenylephrine-induced precontracted aortas. Verapamil attenuated the phenylephrine-induced contraction. The magnitude of the bupivacaine-induced relaxation was higher than that of the bupivacaine-induced $[Ca^{2+}]_i$ decrease in the aortas precontracted with phenylephrine. Conclusions: Taken together, these results suggest that toxic-dose bupivacaine-induced vasodilation appears to be mediated by decreased calcium sensitization in endothelium-denuded aortas precontracted with phenylephrine. In addition, potassium channel inhibitors had no effect on bupivacaine-induced relaxation. Toxic-dose bupivacaine-induced vasodilation may be partially associated with the inhibitory effect of voltage-operated calcium channels.

동종 심장이식 후의 대동맥 혈관병증에 관한 연구

정원상,정윤상,김영학,김혁,강정호,백승삼,송동섭,장효준 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.2

Background: Chronic rejection after a cardiac allograft usually occurs about six months after the operation. Vasculopathy due to chronic rejection causes atherosclerosis in the coronary artery of the transplanted heart and then this causes myocardial injury. We intended to discover and document those findings that occur in a transplanted ascending aorta. Material and Method: In rats weighting 200∼300 gm (Spraque-Dawley rat), we carried out heterotopic heart allo-transplantation with the modified Ono-Lindsey method and then the rats were administrated cyclosporine (10 mg/kg/day). After three months survival, we acquired biopsy materials from the native ascending aorta and the allo-transplanted ascending aorta and we compared them. We classified each severity of 1) intimal thickening, 2) medial hyperplasia, 3) medial calcification, 4) medial inflammation and 5) chondroid metaplasia, which are specific biopsy findings for chronic rejection after a cardiac allograft. Each severity was classified, according to the opinion of one pathologist, in the native ascending aorta biopsies (n=9) and the allo-transplanted ascending aorta biopsies (n=13). The data of the control group and the study group were statistically analyzed with using the Mann-Whitney test (SPSS version 12.0 window). Result: The important changes of the allo-transplanted aorta were intimal thickening (p<0.0001), medial calcification (p=0.045), medial inflammation (p<0.0001) and chondroid metaplasia (p=0.045), but not medial hyperplasia (p=0.36). Conclusion: Cardiac allograft vasculopathy was seen in the transplanted ascending aorta, the same as was seen in the coronary artery, after allograft cardiac transplantation. We have reached the conclusion that chronic rejection also progresses in the aorta. 배경: 동종이형의 심장이식 후에 나타나는 만성 거부반응은 수술 후 약 6개월이 지나 나타나며, 이로 인해 이식된 심장의 관상동맥의 동맥 경화 소견과 심장의 손상을 일으키는 혈관병증이 나타나는 바, 대혈관인 대동맥에서도 이러한 소견을 보이는 지를 확인하고자 하였다. 대상 및 방법: 200∼300 gm의 백서(Spraque-Dawley Rat)에서 이소성의 동종이형의 심장이식(heterotopic heart allo-transplantation)을 Ono-Lindsey method로 시행한 후 사이클로스포린(cyclosporin A 10 mg/kg/day, 종근당 제공)을 투여하여 3개월 이상 생존한 군에서 동물을 희생시킨 후 자가 상행 대동맥과 이식된 심장의 대동맥에서 각각 조직 절편을 얻어 조직 검사를 시행하여 비교하였다. 자가 상행 대동맥의 조직 검사(N=9, native ascending aorta)와 동종 이형의 이식된 심장의 대동맥(N=13, allo-transplanted aorta)의 조직 검사를 동종이형의 심장이식 후의 만성 거부 반응의 특징적인 조직 검사 소견인 1) 내막 비후(intimal thickening), 2) 중층 비후(medial hyperplasia), 3) 중층 석회화(medial calcification), 4) 중층 염증(medial inflammation), 5) 연골 화생(chondroid metaplasia)에 대하여 한 명의 병리의에 의해 대조군과 이식군에서 각각 심한 정도를 통계처리(Mann-Whitney Test, SPSS version 12.0 Windows)하여 비교하였다. 결과: 중층 비후 외(p=0.36)에 내막 비후(p<0.0001), 중층 석회화(p=0.045), 중층 염증(p<0.0001), 연골 화생(p=0.045)에 있어 이식된 심장의 대동맥에서 의미 있는 변화를 보였다. 결론: 동종 이형의 심장 이식 후에 만성 거부 반응에 의한 혈관병증(cardiac allograft vasculopathy)은 관상 동맥을 침범하여 심근의 손상을 가져오며, 이와 같은 만성 거부 반응에 의한 혈관 병증의 변화는 대혈관인 이식된 대동맥에서도 상기의 결과와 같이 나타나 대동맥에서도 만성적인 거부 반응이 진행되고 있음을 확인할 수 있었다.

Bupivacaine-induced Vasodilation Is Mediated by Decreased Calcium Sensitization in Isolated Endothelium-denuded Rat Aortas Precontracted with Phenylephrine

옥성호,배성일,권성춘,박정철,김우찬,박경은,신일우,이헌근,정영균,최문정,손주태 대한통증학회 2014 The Korean Journal of Pain Vol.27 No.3

Background: A toxic dose of bupivacaine produces vasodilation in isolated aortas. The goal of this in vitro study was to investigate the cellular mechanism associated with bupivacaine-induced vasodilation in isolated endotheliumdenuded rat aortas precontracted with phenylephrine. Methods: Isolated endothelium-denuded rat aortas were suspended for isometric tension recordings. The effects of nifedipine, verapamil, iberiotoxin, 4-aminopyridine, barium chloride, and glibenclamide on bupivacaine concentration-response curves were assessed in endothelium-denuded aortas precontracted with phenylephrine. The effect of phenylephrine and KCl used for precontraction on bupivacaine-induced concentration-response curves was assessed. The effects of verapamil on phenylephrine concentration-response curves were assessed. The effects of bupivacaine on the intracellular calcium concentration ([Ca2+]i) and tension in aortas precontracted with phenylephrine were measured simultaneously with the acetoxymethyl ester of a fura-2-loaded aortic strip. Results: Pretreatment with potassium channel inhibitors had no effect on bupivacaine-induced relaxation in the endothelium-denuded aortas precontracted with phenylephrine, whereas verapamil or nifedipine attenuated bupivacaine-induced relaxation. The magnitude of the bupivacaine-induced relaxation was enhanced in the 100 mM KCl-induced precontracted aortas compared with the phenylephrine-induced precontracted aortas. Verapamil attenuated the phenylephrine-induced contraction. The magnitude of the bupivacaine-induced relaxation was higher than that of the bupivacaine-induced [Ca2+]i decrease in the aortas precontracted with phenylephrine.

경식도 심초음파상의 흉부대동맥 죽상경화증의 관찰과 그 의의

이만영(Man Young Lee),정욱성(Wook Seong Chung),승기배(Kie Bae Seung),김종진(Jong Jin Kim),전승석(Seung Seok Chun),노태호(Tai Ho Rho),채장성(Jang Seong Chae),김재형(Jae Hyung Kim),홍순조(Soon Jo Hong),최규보(Kyu Bo Choi) 대한내과학회 1994 대한내과학회지 Vol.46 No.6

N/A Objectives: Atherosclerosis has been suggested to be a generalized disease process. Thus, the pressence of an atherosclerotic cardiovascular event can predict the occurrence of a subsequent event located elsewhere. From a preventive point of view, it would be desirable to have an indicator before the clinical appearance of disease. Ultrasonography has the necessary accuracy, precision, and repeatability to serve as measurement tools of quantitative imaging of large vessel atherosclerosis. Aorta can be examined with relative ease using transesophageal echocardiography. We performed this study to find the prevalence of atherosclerosis of thoracic aorta using transesophageal echocardiography and also to evaluate the association of known atherosclerotic risk factors with its development and clinical significance. Methods: We evaluated the descending thoracic aorta of 548 patients (male 248, female 300: mean age 52±15 yrs), those underwent clinically indicated transesophageal echocardiography. We classified the patients into 4 groups: normal group (270 pts), thin atherosclerotic group (159 pts), thick athrosclerotic group (109 pts) and thick protruded plaque group (17 pts) according to the morphology and thickness of atherosclerotic plaque. Results: 1) Transesophageal echocardiography is a valuable diagnostic tool to assess the severity of atherosclerosis in thoracic aorta and the atherosclerosis of variable degree was commonly encountered in 278 patients of total 548 study subjects. 2) Among the well known atherosclerotic risk factors, the age and the prescnece of hypertension were most strongly related to atherosclerotic process of thoracic aorta. 3) The relations between the atherosclerosis of descending thoracic aorta and the coronany artery disease and cerebral infaction were thought to be weak and need further study. Conclusion: Atherosclerotic lesion of thoracic aorta could be accurately assessed by transesophageal echocardiography. There were close associations between age and hypertension as atherosclerotic risk factors and the atherosclerotic progression of thoracic aorta. Although there are somewhat weak relationships between the degree of atherosclerosis of thoracic aorta and other cardiovascular disease. To elucidate the precise relationship needs further study.

Salt 스트레스에 의한 흰쥐 적출대동맥의 수축력 변화양상

김종일,박태규,김중영 한국환경과학회 2003 한국환경과학회지 Vol.12 No.10

To examine whether salt stress would alter or not contractility of isolated rat aorta. under anesthesia with sodium pentobarbital(50 mg Kg-1 i.p.), male Sprague Dawley rats(300-330 g) N%ere subjected to 0, 50, and 150 mM of sodium chloride at 37℃ for 60 min. Where as the sham group was left at modified Krebs-bicarbonate solution, To measure contractile response of vascular ring preparation isolated from rat was determined in organ bath and was recorded on physiograph connected to isometric transducer. And the strip was checked for expression of heat shock protein(Hsp) by Western blotting. One, three and eight hours later. N%e measured vascular contractility of isolated rat aorta treated with KCI, phenylephrine from organ bath study. The dose-vascular responses of potassium chloride and phenylephrine showed a little augmentation by NaCl concentration in the strips exposed to NaCl for & hours. And the response of relaxation induced by nitroprusside and acetylcholine was not influenced by NaCl stress in isolated aorta ring for 8 hours. respectively. Expression pattern of Hsp 70 of vascular muscle in isolated rat aorta showed a little increase in 150 mM NaCl group at 8 hours after NaCl treatment but not at 3 hours. and Hsp 60 expression of rat aorta was markedly increased in 50 mM NaCl group at 8 hours after NaCl treatment. Taken together, NaCl induced dose- and time dependent accumulation of the Hsp but not affected contraction of rat aorta. These data suggest that short term high salt stress was not sufficient to induce hypertension of rat aorta.

대동맥판막 질환과 동반된 상행대동맥 확장에 대한 봉합봉축법에 의한 대동맥 축소성형술

백만종,나찬영,오삼세,이창하,황성욱,이철,임홍국,김재현,서홍주,김근직 대한흉부외과학회 2005 Journal of Chest Surgery (J Chest Surg) Vol.38 No.3

Background: Reduction aortoplasty has been advocated for dilatation of the ascending aorta associated with aortic valve disease in older, high-risk patients. We report our results with modification of reduction aortoplasty and aortic valve replacement. Material and Method: Between July 2001 and December 2002, 14 consecutive patients who underwent modification of reduction aortoplasty, suture plication technique without excision of the dilated aortic wall, were reviewed. The mean age was 63.7±6.7 (50 to 75) years. Ten patients had congenital bicuspid aortic valve. Twelve patients had severe aortic valve stenosis and 6 had regurgitation of grade III~IV. The diameter of the ascending aorta was measured before and immediately after surgery and 6 and 12 months postoperatively using echocardiography or computed tomography. Follow-up was complete in an average of 14.7±5.4 (7 to 24) months. Result: There were no early postoperative deaths and no bleeding complications. Reduction aortoplasty with suture plication technique decreased the diameter of ascending aorta from 49.4±3.5 mm preoperatively to 33.2±3.4 mm postoperatively (p<0.001). During follow-up, there were no late deaths and no aneurysm recurrence on the ascending aorta. Conclusion: Suture plication technique of reduction aortoplasty without excision of the dilated aortic wall offers good early and short-term results in older, high-risk patients with dilatation of the ascending aorta associated with aortic valve disease. Surgical long-term results of our technique should be evaluated in further studies. 배경: 대동맥 축소성형술은 대동맥판막 질환과 동반된 상행대동맥 확장을 가진 고령 혹은 고위험군의 환자들에서 수술치료의 한 방법이라고 주장되어 왔다. 저자들은 대동맥판막치환술과 동반 시행한 상행대동맥의 변형 축소성형술에 대한 결과에 대해 알아보았다. 대상 및 방법: 2001년 7월부터 2002년 12월까지 상행대동맥벽의 절제 없이 봉합봉축법에 의한 변형 대동맥 축소성형술을 받은 14명의 환자들을 대상으로 하였다. 평균 연령은 63.7 6.7세(50∼75세)였다. 10명의 환자에서 이엽성 대동맥판막이 동반되었다. 10명에서 심한 대동맥판막 협착을 보였으며 6명에서는 III-IV도의 대동맥판막폐쇄부전이 동반되었다. 상행대동맥의 직경은 수술 전과 후 그리고 6개월과 12개월 후에 심장초음파 및 컴퓨터 단층촬영으로 측정하였다. 술 후 평균 추적기간은 14.7 5.4개월(7∼24개월)이었으며 모든 환자에서 추적이 가능하였다. 결과: 술 후 조기 사망이나 출혈과 같은 합병증은 없었다. 봉합봉축법에 의한 대동맥 축소성형술 후 상행대동맥의 직경은 술 전 49.4 3.5 mm에서 술 후 33.2 3.4 mm (p<0.001)로 감소하였다. 추적기간동안 만기 사망이나 상행대동맥의 재확장은 없었다. 결론: 대동맥벽의 절제없이 봉합봉축법에 의한 변형 대동맥축소성형술은 대동맥판막 질환과 동반된 상행대동맥 확장을 가진 고령 혹은 고위험군의 환자들에서 양호한 조기 및 중기성적을 보였다. 하지만 본 방법을 사용한 환자들에 대한 장기 추적결과에 추가적인 연구가 필요하리라 생각한다.

LETTER TO THE EDITOR : Unexpected development of acute abdominal aortic thrombosis during percutaneous coronary intervention

( Sang Jin Ha ),( Joo Hyeong Oh ),( Soo Joong Kim ) 대한내과학회 2014 The Korean Journal of Internal Medicine Vol.29 No.5

Acute aortic occlusion by a thrombus is an uncommon vascular emergency during percutaneous coronary intervention (PCI), which may lead to shock and death. We report on a patient who experienced acute thrombosis at the aortoiliac bifurcation and was treated by aspirating a thrombus and implanting a stent in the aorta. An 82-year-old female with a history of hypertension, diabetes, atrial fibrillation, and cerebral infarction was referred to the Cardiology Department due to chest discomfort and elevated cardiac biomarkers (creatinine kinase/ creatinine kinase-MB, 33/7.0 IU/L; troponin I, 0.18 ng/mL) before a colorectal f istula operation. Coronary angiography was performed under the impression of a non-ST elevation myocardial infarction, which clearly showed a high-grade stenosis in the mid-portion of the left anterior descending (LAD) artery with minimal luminal area < 2 mm2 on the intravascular ultrasound evaluation (Fig. 1). Unfractionated heparin (70 units/ kg) was administered initially. Then, activated clotting time was monitored and maintained at 200 to 300 seconds by an additional injection of heparin during PCI. When a guiding catheter (JL 7 Fr) was engaged into the LAD artery, central blood pressure decreased and unusual f lat pattern pressure curves appeared, together with dizziness (Fig. 2A). We retracted the guiding catheter and performed aortography through the contralateral femoral artery. No aortic dissection was detected in the ascending or descending aorta. However, aortography showed a huge, lumen-occluding thrombi at the level of aortoiliac bifurcation (Fig. 2B). We initially infused 200,000 U tissue plasminogen activator into the aortic bifurcation through the guiding catheter and manually aspirated using a 9-Fr long sheath, but huge thrombi remained in the aortoiliac bifurcation, and an angiogram showed no pathological evidence of abdominal aorta bifurcation such as severe occlusive disease, aortic dissection, or abdominal aortic aneurysm (Fig. 2C). The aspirated material was a 6-cm black-colored thrombus (Fig. 2D). We inserted a stent in the aorta and two self-expandable aortic stents (10 mm × 6 cm at the left side and 10 mm × 8 cm at the right side (Zilver, Cook Medical, Bloomington, IN, USA) were implanted at the aortoiliac bifurcation. After deployment of the stents, additional ballooning (8 mm × 4 cm, Rider, Cook Medical) was performed. A final angiogram showed a good result (Fig. 3). The patient recovered well after stent implantation, with blood pressure of 110/70 mmHg. She underwent PCI successfully at the mid-LAD artery and was discharged uneventfully 7 days later. Acute thrombotic occlusion of the aorta during PCI is a rare event, resulting in disastrous consequences unless an early diagnosis is made and appropriate management initiated [1]. The cause of an occlusion is a saddle embolus at the aortoiliac bifurcation or acute in situ thrombosis on a background of severe occlusive disease, aortic dissection, acute thrombosis of an abdominal aortic aneurysm, vasculitis, hypercoagulability, or aortic trauma [2]. Other uncommon causes include a fungal infection, acute thrombosis of abdominal aortic stent-graft in heparin-induced thrombocytopenia, or chemotherapy-related thrombosis [3-5]. Compared with other causes of acute aortic occlusion, acute thrombosis at the aortoiliac bifurcation during PCI is extremely rare. As a prerequisite check before guiding catheter engagement, we assessed the activated partial thromboplastin time and flushed the femoral sheath with saline, but no abnormal findings were detected. In this case, no abnormal findings in the aorta were observed, including aneurysm, dissection, or trauma. We also examined protein C and S activity, erythrocyte sedimentation rate, C-reactive protein, complement 3 and 4, and antineutrophil cytoplasmic antibody to evaluate hypercoagulability and vasculitis, but no abnormal results were found. No fungal infection was identified. Atrial fibrillation was another possible contributor to embolic occlusion but there was no thrombus in the left atrial appendage or left ventricle on echocardiography. Therefore, we finally suspected a saddle embolus originating from the femoral sheath and an in situ thrombosis at the aortoiliac bifurcation as a possible cause of this PCI-related aortic complication. Anticoagulation should be initiated immediately once the diagnosis of acute thrombotic occlusion in aorta is made, and early revascularization should be the goal. Possible revascularization approaches include thromboembolectomy, aortic reconstruction, anatomic or extra-anatomic bypass, and thrombolysis. The choice of approach depends on the etiology, anatomy, and patient factors. Surgical thrombectomy has frequently been used for treatment of an acute aortic occlusion. However, recent advances in endovascular techniques could decrease the high mortality rate associated with surgical treatment of this disease and warrants consideration as a treatment option. In this case, we decided on endovascular treatment for revascularization with thrombolysis, thrombus aspiration, and stent implantation using a contralateral approach. In conclusion, acute thrombosis can occur at the aortoiliac bifurcation during PCI. Therefore, operators should pay attention to the development of aortic complications upon encountering an abnormal central blood pressure pattern and consider an appropriate treatment method.including an endovascular approach.for acute aortic thrombosis.