Acute abdominal aortic ride-through embolism is a catastrophic vascular disease for both doctors and patients, with high disability and mortality rates, and has been on the rise in recent years with the increase of vascular diseases in China, which requires us to reacquaint ourselves with the disease. A total of 22 cases of abdominal aortic jockey embolism were collected from May 1996 to June 2010 and analyzed and reported as follows. 1. Clinical data 1.1 General data: 22 cases in this group, 13 male, 9 female, age 13.5-83.3 years old, average 58.5±8.7 years old; duration of the disease is 3-92h, average 35±8h, 4 cases within 12h, 10 cases from 24 to 48h. 8 cases are more than 48 hours. There were 5 cases of rheumatic heart disease, 3 cases of coronary heart disease combined with atrial fibrillation, and 1 case of old myocardial infarction. After admission, there were 4 cases of left atrial mucinous tumor and 9 cases of unknown cause. First hospitalization department: orthopedics 7 cases, neurology 9 cases, vascular surgery 3 cases, emergency department 3 cases. 1.2 Clinical manifestations: The onset of the disease was acute, 4 cases were triggered by physical labor, and the rest had no obvious triggers. The main manifestations were sudden pain, numbness, coldness and motor disorder of both lower limbs, loss of motor function and paraplegia in 8 cases; ischemic manifestations of both lower limbs appeared simultaneously in 16 cases, and one side of the limbs appeared first in 6 cases; bruising, cyanosis, dark violet, or maculopapular changes below the knee joint, loss of sensation and motor ability in 4 cases; loss of thighs in 15 cases; and loss of motor ability in 3 cases. Loss of sensation and motor ability; 15 cases showed bruising, cyanosis, dark purple or mottled changes below the middle thigh, and loss of sensation and motor ability; 3 cases showed bilateral buttocks, lower abdominal skin hemorrhagic spots and edema-like changes. 1.3 Treatment: All patients were given heparin at 200 U/kg body weight on admission; 19 cases underwent emergency color Doppler ultrasonography, suggesting thrombus occlusion of the lower end of the abdominal aorta and the bifurcation, of which 4 cases had embolisms near bilateral renal arteries, and there was no blood flow signal in the arteries of the bilateral lower limbs or the blood flow signals were very weakened; 2 cases were confirmed by emergency arteriograms; and 1 case was confirmed by MRI; and 2 cases of patients aged 80 years old and above were in near-death situation due to the long course of the disease, and were in a critical condition due to their poor health. Two patients over 80 years of age were treated conservatively due to the long course of the disease and near-death status, while the remaining 20 cases were treated surgically, of which 3 cases were combined with heart failure, and were first given anti-heart failure treatment, and then started surgery when their heart function improved. Fogarty catheter thrombolysis was performed under general anesthesia in all surgical patients, and thrombolysis was performed in 16 cases via bilateral femoral arteries: after heparinization (1 mg/kg), the anterior wall was incised longitudinally, and a No. 6 Fogarty balloon catheter was inserted into the proximal end of the femoral artery to the abdominal aorta, which was repeated several times until the blood spraying was fluent and then blocked, and thrombolysis of contralateral femoral arteries was carried out with the same method, and if necessary, the femoral arteries were inserted with Fogarty balloon catheters at the same time. If necessary, insert the Fogarty balloon catheter into both femoral arteries at the same time to take the thrombus, and strive to take all the thrombus; insert the distal femoral artery, take out the embolus, and then block it after satisfactory blood flow; there were 5 cases of secondary thrombosis in the femoral artery in this group, and after taking the embolus, 250,000u of urokinase was injected into the distal arteries. Suture the incision of the femoral arteries bilaterally to restore blood flow. Two cases of thrombus extraction via iliac artery and external iliac artery: because the Fogarty catheter could not go upward, the iliac artery and external iliac artery were dissected out, which were severely twisted, the twisted blood vessels were fully freed, and the twisted blood vessels were incised at the reflexion point, and the Fogarty catheter was applied to extract the thrombus from up and down, and the operation was successful. Transabdominal thrombectomy was performed in 2 cases: the distal abdominal aorta and both common iliac arteries were exposed through a mid-abdominal incision. After heparinization, the abdominal aorta and bilateral common iliac arteries were blocked, the anterior wall of the distal abdominal aorta was incised longitudinally and the embolus was removed under direct vision, and Fogarty balloon catheters No. 5 and No. 4 were inserted into the bilateral common iliac arteries and femoral arteries to extract the embolus several times until the return of blood from the bilateral common iliac arteries was well blocked, and the anterior wall of the abdominal aorta was closed with sutures. Before restoring the blood flow of the lower limbs after thrombolysis, 250 ml of 5% sodium bicarbonate and 10 mg of dexamethasone were injected intravenously, and all of them were admitted to ICU for close observation of the changes of vital signs, correction of the water-electrolyte disorders and the acid-base imbalance, and 8 of them were put on artificial renal dialysis for 36 hours, and at the same time, they underwent anticoagulant and thrombolytic treatments. 1.4 Results: There were 10 perioperative deaths: 2 cases died of conservative treatment because they were already in a state of near-death when they came to the hospital, 3 cases died of toxin absorption within 36h after surgery (before artificial renal dialysis was used), 4 cases died of acute renal failure, and 1 case died of massive myocardial infarction. Three of the 12 survivors underwent above-knee amputation due to limb necrosis or severe osteofascial compartment syndrome, one of which was bilateral. one patient developed an ocular arterial embolism on one side of the eye during hospitalization resulting in blindness. The remaining 8 patients recovered. The remaining 8 patients recovered. None of the surviving patients had severe ischemic symptoms such as intermittent claudication in their lower limbs. 2.1 Diagnosis: Acute abdominal aortic embolism has a sudden onset, rapid development and characteristic clinical manifestations, so the diagnosis is generally not difficult. However, due to the rarity of this case, it cannot attract the attention of some primary physicians or non-vascular surgeons, so it is easy to cause misdiagnosis and delayed diagnosis. In this group, 7 cases were first hospitalized in the department of orthopedics, 9 cases in the department of neurology, 3 cases in the department of vascular surgery, and 3 cases in the department of emergency department of retention and investigation; 4 patients underwent intervertebral disc surgery in the lower hospitals and in our hospital, and 5 patients were treated in the department of neurology for more than 2 days, and the possibility of the disease was not considered until the appearance of obvious changes in the limbs. Therefore, the first priority in the diagnosis of this disease is to increase the vigilance of non-vascular surgeons. Characteristic features of abdominal aortic ride-over embolism include: rapid onset, rapid progression of the disease, very easy to deteriorate; a wide range of disease involvement, often involving the abdomen, buttocks, and both lower limbs; ischemic manifestations of both lower limbs appear simultaneously, and are progressively aggravated. It is not difficult to diagnose according to the above manifestations. Color Doppler ultrasound is the main auxiliary examination, which can make a clear diagnosis, and bedside color Doppler ultrasound is more suitable for patients with serious illness. When color Doppler ultrasound is in doubt, CTA, MRA, and DSA can be used to find out whether there is a possibility of embolization of the superior mesenteric artery, renal artery, other lesions in the aorta or iliac artery, serious sclerosis of the arterial wall, stenosis and tortuosity, and the status of collateral circulation. However, these examinations take several hours and may delay the timing of treatment, so they should not be routinely used for acute abdominal aortic ride-through embolization that develops rapidly and has a serious prognosis. 2.2 The causes of perioperative deaths and possible solutions: 10 cases of perioperative deaths in this group. 2 cases died of conservative treatment because they were already in a state of near-death when they came to the hospital, 3 cases died of toxin or muscle necrosis product absorption (including high K+) within 36h after the operation, 4 cases died because of acute renal failure, and 1 case died because of massive myocardial infarction. This shows that toxin absorption and acute renal failure are the main causes of death, which arise from ischemic rhabdomyolysis and the resulting myopathic nephrotic syndrome (MMS). We had 4 deaths (4/14) due to toxin absorption before 2004, and since 2004 the mortality rate due to toxin absorption has decreased to zero using continuous renal replacement therapy (CRRT) in all 8 patients. CRRT not only reduces the burden on the patient’s kidneys, but also mitigates the effects on brain, respiratory, and circulatory functions due to renal insufficiency and cytotoxicity, and we believe that CRRT is an important means of decreasing postoperative complications and decreasing surgical mortality [4]. However, two patients still died of acute renal failure after the use of CRRT, which was mainly caused by the obstruction of renal tubules by large amounts of myoglobin. We used methods such as strengthening the monitoring of renal function, maintaining effective circulating volume, water and electrolyte balance, correcting acidosis, applying diuretics, and alkalinizing urine [5], but the effect is poor and needs further study. Improving the early diagnosis and timely treatment of this disease is certainly one of the main methods, and we consider that amputation of limbs with more obvious necrosis before removing the bolus may reduce the incidence of acute renal failure and mortality. In our group, one case of combined left atrial mucinous aneurysm was operated only with thrombectomy, and the rupture of the mucinous aneurysm led to blindness due to embolization of the ophthalmic artery on one side during hospitalization, which was unfortunate. Therefore, we propose that cardiac color Doppler ultrasonography should be routinely performed in patients with abdominal aortic jockey embolism, and that a one-stage left atrial mucinous aneurysm removal should be performed in patients with mild disease.