|
1
|
Esnaola Barriola I, Escriche Gorospe E, Miguel Navas P, Martínez Campos E, Molina Goicoechea M, Capell Pascual F, Jiménez Delgado A, Muñoz Arrondo R. Suprasternal aortic arch echocardioscopy as a potential tool in detection and follow-up of mobile thrombi in patients with ischemic stroke. Front Neurol 2025; 15:1528325. [PMID: 39845932 PMCID: PMC11752908 DOI: 10.3389/fneur.2024.1528325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 12/16/2024] [Indexed: 01/24/2025] Open
Abstract
Introduction Severe or complicated atheromatosis of the aortic arch represents an important and often underdiagnosed embolic source in patients with ischemic stroke. The presence of a floating thrombus has significant clinical relevance, as it is associated with a high risk of early recurrence. The aim of this study was to analyze the potential of echocardiographic examination through the suprasternal window in both the detection of embolic sources and the monitoring of the response to anticoagulant treatment in patients with mobile thrombi. Methods This case series study included ten consecutive patients with a mobile floating aortic arch thrombus associated with an atheromatous plaque, detected by focused echocardiography and confirmed by Computed Tomography Angiography (CTA). Epidemiological, clinical, radiological, and ultrasound characteristics were analyzed. Clinical and ultrasound follow-up was performed after initiation of anticoagulation as secondary prevention to assess the efficacy and safety of this treatment. Results Ten patients (seven female) with a mean age of 76 years were identified. After anticoagulation, a complete resolution of the mobile thrombus was observed in eight of them during ultrasound follow-up. One patient suffered an ischemic recurrence. Two patients receiving associated antiplatelet therapy presented severe hemorrhagic complications, one of which was fatal. Once the disappearance of the mobile thrombus was detected, anticoagulation was discontinued, and no further ischemic recurrences were observed. Discussion Floating thrombus of the aortic arch is an underdiagnosed but clinically relevant condition. The study of the aortic arch with echocardiography through the suprasternal window is a highly available and harmless technique, that may be highly useful for the detection and monitoring of response to treatment of this pathology. Furthermore, early anticoagulation could be an effective and safe treatment in these patients.
Collapse
|
|
2
|
Tajima S, Kudo T, Mori D, Kitabayashi K. Floating ascending aortic thrombus with antiphospholipid syndrome: a case report. GENERAL THORACIC AND CARDIOVASCULAR SURGERY CASES 2024; 3:49. [PMID: 39517090 PMCID: PMC11545842 DOI: 10.1186/s44215-024-00174-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 10/26/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Ascending aortic thrombus is a rare disease that can cause fatal thromboembolism. The treatment for the disease is not well defined and depends on the clinical experience of surgeons. Most reports of thrombosis in antiphospholipid syndrome (APS) are associated with venous or peripheral arterial thrombosis, and there are almost no reports of thrombosis of the aorta. CASE PRESENTATION A 74-year-old male was referred to our department with claudication of the left leg lasting 3 months. A computed tomography angiography (CTA) and a transthoracic echocardiography demonstrated that a floating and pedunculated mass associated with APS was located at ascending aortic lumen and an embolism in the left superficial femoral artery. Under deep hypothermic circulatory arrest, we resected a floating mass without the graft replacement. CTA 1 year after surgery showed no recurrence of thrombus. CONCLUSION We experienced a rare case of floating ascending aortic thrombi. As in this case, we consider that a floating ascending aortic thrombus with embolic events should be performed by surgical intervention.
Collapse
Affiliation(s)
- Shinya Tajima
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Tomoaki Kudo
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Daisuke Mori
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Katsukiyo Kitabayashi
- Department of Cardiovascular Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| |
Collapse
|
|
3
|
Mendes D, Veiga C, Machado R, Sá-Pinto P, Almeida R. The Challenge of Managing a Primary Aortic Mural Thrombus: Outcomes and Technical Considerations. Int J Angiol 2024; 33:156-164. [PMID: 39131810 PMCID: PMC11315603 DOI: 10.1055/s-0044-1779489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
Background: Embolization to multiple arterial beds associated with primary aortic mural thrombus (PAMT) could result in high morbidity and mortality. There are no recommendations to dictate the best management. This study aims to describe our experience in managing this rare disease. Methods: A retrospective review of all patients affected by PAMT treated at our institution between January 2015 and December 2021 was performed. Recorded data included demographics, prothrombotic risk factors, imaging findings, clinical presentation, and treatment. Primary outcomes comprised thrombus recurrence, major amputation, and death. Results: Thirteen patients with PAMT have been included. The median age was 52 years (36-68 years), and the male/female ratio was 1:1.6. The diagnosis of PAMT was made by computed tomography angiography (CTA) in all cases. Prothrombotic conditions were identified in 92% of cases, and most patients (92%) had thoracic PAMT. The most common presentation was acute limb ischemia after thrombus embolization (85%), requiring surgical revascularization. Anticoagulation was promptly started in all patients. Two patients developed heparin-induced thrombocytopenia. Recurrence of embolization/thrombosis was observed in 54% of patients; two underwent endovascular thrombus exclusion with a stent graft. We identified one PAMT-related death and one major amputation with a median follow-up time of 39 months (12-64 months). Conclusion: Anticoagulation alone as initial therapy could completely resolve PAMT but is associated with high embolization recurrence. Thoracic endovascular aortic repair is feasible and could prevent additional embolization. However, the criteria for its use as a first-line therapy still need to be defined. Our study highlights the importance of closely monitoring these patients.
Collapse
Affiliation(s)
- Daniel Mendes
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Carlos Veiga
- Department of Angiology and Vascular Surgery, Hospital de Braga, Braga, Portugal
| | - Rui Machado
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Pedro Sá-Pinto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Rui Almeida
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| |
Collapse
|
|
4
|
Jayyusi F, AlBarakat MM, Al-Rousan HH, Alawajneh MM, Alkasabrah AR, Abujaber M, Aldabbas ME, Abuelsamen M, Alshgerat Y, Sayuri Y, Alhertani N, BaniAmer M, Shari I, Brašić JR. The Efficacy of Medical Interventions for Free-Floating Thrombus in Cerebrovascular Events: A Systematic Review. Brain Sci 2024; 14:801. [PMID: 39199493 PMCID: PMC11352359 DOI: 10.3390/brainsci14080801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/03/2024] [Accepted: 08/07/2024] [Indexed: 09/01/2024] Open
Abstract
Although free-floating thrombus (FFT) poses a significant risk of stroke or transient ischemic attack (TIA), optimal management strategies are uncertain. To determine the state-of-the-art of medical interventions for FFT, we conducted a systematic review of the efficacy of various medical interventions and factors influencing FFT resolution and recurrence. A comprehensive search of Embase, PubMed, and ScienceDirect identified 61 studies encompassing 179 patients with FFT-related stroke or TIA treated with anticoagulants, antiplatelets, or their combinations. Primary outcomes assessed were stroke recurrence and thrombus resolution. Statistical analyses (Fisher's exact test, chi-square test, Mann-Whitney test, and Kruskal-Wallis test) utilized significance set at p < 0.05. Over a median follow-up of 7 months, thrombus resolution occurred in 65% of patients, while 11.2% experienced recurrence, primarily as TIAs. Cardioembolism was significantly less common in resolved cases (p = 0.025). Combination therapy (antiplatelets, anticoagulants, and statins) significantly enhanced clot resolution (OR 11.4; 95% CI 1.436-91.91; p = 0.021) compared to monotherapies. Ulcerated plaque was a significant predictor of recurrence (OR 8.2; 95% CI 1.02-66.07; p = 0.048). These findings underscore the superiority of combination therapy in FFT management and highlight the need for targeted interventions in patients with ulcerated plaques to mitigate recurrence risk.
Collapse
Affiliation(s)
- Fairoz Jayyusi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Majd M. AlBarakat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Habib H. Al-Rousan
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Mohmmad M. Alawajneh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Abdel Rahman Alkasabrah
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Mo’tasem Abujaber
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Mohammed E. Aldabbas
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Mustafa Abuelsamen
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Yahya Alshgerat
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Yahia Sayuri
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Nazeeh Alhertani
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Mohammad BaniAmer
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - Issa Shari
- Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; (F.J.); (M.M.A.); (H.H.A.-R.); (M.M.A.); (A.R.A.); (M.A.); (M.E.A.); (M.A.); (Y.A.); (Y.S.); (N.A.); (M.B.).; (I.S.)
| | - James Robert Brašić
- Department of Psychiatry, New York City Health and Hospitals/Bellevue, New York, NY 10016, USA
- Department of Psychiatry, New York University Grossman School of Medicine, New York University Langone Health, New York, NY 10016, USA
- Section of High-Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| |
Collapse
|
|
5
|
Wilson WR, McCusker KH, Peeran SM, Dourdoufis PJ. Endovascular removal of a large free-floating thrombus of the descending thoracic aorta using the AngioVac system. J Vasc Surg Cases Innov Tech 2024; 10:101460. [PMID: 38591019 PMCID: PMC11000156 DOI: 10.1016/j.jvscit.2024.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
Free-floating aortic mural thrombus in the minimally diseased or nonaneurysmal aorta is a rare, clinically significant source of peripheral embolism. We describe a 41-year-old woman with a history of left brachial thromboembolectomy who presented atypical chest pain. Computed tomography angiography and transesophageal echocardiography revealed a 14.0 cm × 1.4 cm mobile mass in the proximal descending thoracic aorta. The thrombus was removed through a minimally invasive catheter-based approach using the AngioVac system.
Collapse
Affiliation(s)
- William R. Wilson
- Department of Cardiothoracic and Vascular Surgery, Portsmouth Regional Hospital, Portsmouth, NH
| | - Kevin H. McCusker
- Department of Cardiothoracic and Vascular Surgery, Portsmouth Regional Hospital, Portsmouth, NH
| | - Syed M. Peeran
- Department of Cardiothoracic and Vascular Surgery, Portsmouth Regional Hospital, Portsmouth, NH
| | | |
Collapse
|
|
6
|
Liu H, Yu Z, Xu Y, Zhou Y, Yang J, Qiu Y, Xing Y, Peng F, Tang W. Repeated acute coronary syndrome caused by a mind-bending mural thrombus in ascending aorta: a case report and review of the literature. BMC Cardiovasc Disord 2024; 24:281. [PMID: 38811879 PMCID: PMC11134645 DOI: 10.1186/s12872-024-03956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Acute coronary syndrome due to coronary artery embolism in the setting of ascending aortic thrombus is an uncommon condition, even rarer when there is no aortic pathology such as aneurysm, severe atherosclerosis, aortic dissection, or thrombophilia (whether inherited or acquired). CASE PRESENTATION We report a case of a 58-year-old male presented with acute chest pain, electrocardiogram showing non-ST-elevation acute coronary syndrome. The computed tomography angiography of coronary artery revealed a mural thrombus in the proximal part of ascending aorta, located above the left coronary artery ostium, without any aortic pathologies. With the exception of hypertension and cigarette smoking, no other risk factors were identified in this patient that may increase the risk of thrombosis. Given the life-threatening risk of interventional therapy and surgery, the patient determinedly opted for anticoagulant and dual antiplatelet therapy. Then he experienced the reoccurrence of chest pain after 6-day treatment, progressed to anterior and inferior ST-segment elevation myocardial infarction. Coronary artery embolism originating from the ascending aortic thrombus was suspected. Considering the hemodynamic instability of the patient, the medical treatment was continued and bridged to warfarin and aspirin after discharge. Follow-up computed tomography angiography at 6 months showed no obstruction in coronary artery and complete resolution of the thrombus. No thromboembolic events occurred henceforward. CONCLUSIONS Acute coronary syndrome could be a manifestation of secondary coronary embolism due to ascending aortic thrombus. Currently, there is no standardized guideline for the treatment of aortic mural thrombus, individualized treatment is recommended. When surgical therapy is not applicable for the patient, anticoagulation and dual antiplatelet treatment are alternative treatments that may successfully lead to the resolution of the aortic thrombus.
Collapse
Affiliation(s)
- Hanxuan Liu
- School of Medicine, Shaoxing University, Shaoxing City 312000, Zhejiang Province, China
| | - Zhangjie Yu
- Department of Cardiology, Shaoxing People's Hospital, NO. 568 North Zhongxing Road, Yuecheng district, Shaoxing City 312000, Zhejiang Province, China
| | - Ying Xu
- School of Medicine, Shaoxing University, Shaoxing City 312000, Zhejiang Province, China
| | - Yan Zhou
- Department of Cardiology, Shaoxing People's Hospital, NO. 568 North Zhongxing Road, Yuecheng district, Shaoxing City 312000, Zhejiang Province, China
| | - Juntao Yang
- School of Medicine, Shaoxing University, Shaoxing City 312000, Zhejiang Province, China
| | - Yinyin Qiu
- School of Medicine, Shaoxing University, Shaoxing City 312000, Zhejiang Province, China
| | - Yangbo Xing
- Department of Cardiology, Shaoxing People's Hospital, NO. 568 North Zhongxing Road, Yuecheng district, Shaoxing City 312000, Zhejiang Province, China
| | - Fang Peng
- Department of Cardiology, Shaoxing People's Hospital, NO. 568 North Zhongxing Road, Yuecheng district, Shaoxing City 312000, Zhejiang Province, China
| | - Weiliang Tang
- Department of Cardiology, Shaoxing People's Hospital, NO. 568 North Zhongxing Road, Yuecheng district, Shaoxing City 312000, Zhejiang Province, China.
| |
Collapse
|
|
7
|
Inoue K, Ogata T, Mishima T, Ishibashi H, Hirai F, Tsuboi Y. [Embolic stroke due to ascending aortic thrombus in a patient with treatment-resistant ulcerative colitis]. Rinsho Shinkeigaku 2024; 64:93-98. [PMID: 38246606 DOI: 10.5692/clinicalneurol.cn-001901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The patient was a 49-year-old man presenting with recurrent melena due to progressive ulcerative colitis. One day, he developed left lower facial weakness and dysarthria, and the next day, he was transferred to our hospital because of muscle weakness in his left upper and lower extremities. On admission, neurological findings revealed left hemiplegia, including left facial palsy, dysarthria, and left hemispatial neglect. Brain MRI with diffusion-weighted image showed a fresh infarction in the right anterior and middle cerebral artery territory. Contrast-enhanced CT showed thrombus in the ascending aorta in addition to occlusion of the right internal carotid artery, suggesting the diagnosis of cerebral infarction with an embolic source in the aortic lesion. The intra-aortic thrombus disappeared after 48th day of antithrombotic therapy. Laboratory findings revealed elevated blood viscosity, proteinase-3-anti-neutrophil cytoplasmic antibody (PR3-ANCA), and β2GP1-IgG antibodies, suggesting that the cause of the aortic thrombus may be due to elevated blood viscosity and autoantibodies, as well as highly active ulcerative colitis.
Collapse
Affiliation(s)
- Kenichi Inoue
- Department of Neurology, Faculty of Medicine, Fukuoka University
| | - Toshiyasu Ogata
- Department of Neurology, Faculty of Medicine, Fukuoka University
| | - Takayasu Mishima
- Department of Neurology, Faculty of Medicine, Fukuoka University
| | - Hideki Ishibashi
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University
| | - Fumihito Hirai
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University
| |
Collapse
|
|
8
|
Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | | |
Collapse
|
|
9
|
Parenti VG, Vijay K, Maroules CD, Majdalany BS, Koweek LM, Khaja MS, Ghoshhajra BB, Agarwal PP, Contrella BN, Keefe NA, Lo BM, Malik SB, Surasi DS, Waite K, Williamson EE, Abbara S, Dill KE. ACR Appropriateness Criteria® Workup of Noncerebral Systemic Arterial Embolic Source. J Am Coll Radiol 2023; 20:S285-S300. [PMID: 37236749 DOI: 10.1016/j.jacr.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Noncerebral systemic arterial embolism, which can originate from cardiac and noncardiac sources, is an important cause of patient morbidity and mortality. When an embolic source dislodges, the resulting embolus can occlude a variety of peripheral and visceral arteries causing ischemia. Characteristic locations for noncerebral arterial occlusion include the upper extremities, abdominal viscera, and lower extremities. Ischemia in these regions can progress to tissue infarction resulting in limb amputation, bowel resection, or nephrectomy. Determining the source of arterial embolism is essential in order to direct treatment decisions. This document reviews the appropriateness category of various imaging procedures available to determine the source of the arterial embolism. The variants included in this document are known arterial occlusion in the upper extremity, lower extremity, mesentery, kidneys, and multiorgan distribution that are suspected to be of embolic etiology. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
- Vincent G Parenti
- Research Author, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | - Lynne M Koweek
- Panel Chair, Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | - Nicole A Keefe
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Sachin B Malik
- VA Palo Alto Health Care System, Palo Alto, California and Stanford University, Stanford, California
| | - Devaki Shilpa Surasi
- The University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Kathleen Waite
- Duke University Medical Center, Durham, North Carolina, Primary care physician
| | - Eric E Williamson
- Mayo Clinic, Rochester, Minnesota; Society of Cardiovascular Computed Tomography
| | - Suhny Abbara
- Specialty Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Karin E Dill
- Specialty Chair, Emory University Hospital, Atlanta, Georgia
| |
Collapse
|
|
10
|
Hirata R, Tago M, Nakashima T, Hirakawa Y. A floating mural thrombus in the ascending aorta can cause multiorgan infarction. BMJ Case Rep 2022; 15:e250147. [PMID: 36328361 PMCID: PMC9639026 DOI: 10.1136/bcr-2022-250147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
A man in his 50s with sudden-onset left-sided subcostal pain was diagnosed with splenic infarction by thoracoabdominal CT with contrast enhancement, which also revealed a mural thrombus in the thoracoabdominal aorta, raising the possibility of aortic dissection. The electrocardiographic findings were normal and transthoracic echocardiography did not detect thrombus in the heart. Antihypertensive medication was administered on admission, and anticoagulation therapy was started after he developed left renal infarction and occlusion of the superior mesenteric artery. Nevertheless, he subsequently sustained an acute cerebral infarction. Transoesophageal echocardiography revealed an abnormal floating structure in the ascending aorta, which was surgically removed and finally diagnosed as an organising thrombus. Although most of the causes of multiorgan infarction are cardiogenic, floating mural thrombus can also be a cause. Anticoagulation therapy may be necessary for patients with recurring severe embolisms even when aortic dissection has not been completely ruled out.
Collapse
Affiliation(s)
- Risa Hirata
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | | | - Yuka Hirakawa
- Department of General Medicine, Saga University Hospital, Saga, Japan
| |
Collapse
|
|
11
|
Sato N, Mishima T, Okubo Y, Okamoto T, Shiraishi S, Tsuchida M. Acute aortic thrombosis in the ascending aorta after cisplatin-based chemotherapy for esophageal cancer: a case report. Surg Case Rep 2022; 8:75. [PMID: 35461358 PMCID: PMC9035195 DOI: 10.1186/s40792-022-01431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The risk of thrombus development is considered to be increased by malignant tumors and chemotherapy. In addition, thrombosis of the ascending aorta is rare. We report a case of ascending aortic thrombectomy in a patient with esophageal cancer who developed ascending aortic thrombus after starting neoadjuvant chemotherapy, including operative findings and surgical treatment. CASE PRESENTATION A 63-year-old man with esophageal cancer was administered chemotherapy comprising cisplatin plus 5-fluorouracil. A week after completing 1 cycle of chemotherapy, computed tomography angiography showed acute aortic thrombosis at the ascending aorta. The risk of embolization appeared high because the thrombosis was floating, so we performed emergency ascending aortic thrombectomy. The postoperative course was good and uncomplicated. A month after this surgery, the patient underwent surgery for esophageal cancer. As of 1 year after the cancer surgery, neither cancer nor thrombosis has recurred. CONCLUSION We describe a case of acute aortic thrombosis in the ascending aorta after cisplatin-based chemotherapy, that was treated by aortic thrombectomy. The treatment strategy should depend on thrombus location and the condition of the patient, but surgical treatment should be considered where possible to achieve better prognosis.
Collapse
Affiliation(s)
- Noriaki Sato
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Niigata, Japan.
| | - Takehito Mishima
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Niigata, Japan
| | - Yuka Okubo
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Niigata, Japan
| | - Takeshi Okamoto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Niigata, Japan
| | - Shuichi Shiraishi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Niigata, Japan
| |
Collapse
|
|
12
|
Vaidya YP, Schaffert TF, Shaw PM, Costanza MJ. Management of mobile thrombus of the thoracic aorta. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:627-629. [PMID: 34693090 PMCID: PMC8515161 DOI: 10.1016/j.jvscit.2021.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022]
Abstract
Mobile thrombus of the nonaneurysmal, nonatherosclerotic aorta is a rare condition but presents with catastrophic embolic events. We describe two cases that demonstrate differences in presentation and treatment strategies. We review the literature to discuss initial management as well as surgical options. However, due to the limited number of cases, no definitive guidelines for management exist.
Collapse
Affiliation(s)
- Yash P Vaidya
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY
| | - Tonio F Schaffert
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY
| | - Palma M Shaw
- Department of Vascular Surgery, SUNY Upstate Medical University, Syracuse, NY
| | - Michael J Costanza
- Department of Vascular Surgery, SUNY Upstate Medical University, Syracuse, NY
| |
Collapse
|
|
13
|
Incidentally Found Ascending Aortic Thrombus: Presentation and Management. JACC Case Rep 2021; 3:1489-1493. [PMID: 34693348 PMCID: PMC8511466 DOI: 10.1016/j.jaccas.2021.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/19/2021] [Indexed: 11/21/2022]
Abstract
Aortic thrombus can be rare, requiring prompt recognition and management to prevent sequelae. Treatment modalities for aortic thrombus include systemic anticoagulation, endovascular, and/or surgical intervention. We present an incidental finding of an aortic annular mass in a 53-year-old male consistent with an aortic thrombus. (Level of Difficulty: Intermediate.)
Collapse
|
|
14
|
Shoda M, Yamamoto H, Kawashima M, Kondo T, Murakami H, Kawai H, Takaya T. Acute Coronary and Cerebral Emboli From a Pedunculated Ascending Aorta Thrombus. JACC Case Rep 2021; 3:1194-1199. [PMID: 34401758 PMCID: PMC8353561 DOI: 10.1016/j.jaccas.2021.04.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022]
Abstract
Hyperprolactinemia is a risk factor for thrombus formation. We present a rare case of a mobile ascending aorta thrombus leading to acute myocardial infarction and cerebral infarction in a patient with idiopathic hyperprolactinemia. (Level of Difficulty: Beginner.).
Collapse
Affiliation(s)
- Mitsuhiko Shoda
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, Himeji, Japan
| | - Hiroyuki Yamamoto
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, Himeji, Japan
| | - Motoharu Kawashima
- Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan
| | - Takeshi Kondo
- Division of Legal Medicine, Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirohisa Murakami
- Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan
| | - Hiroya Kawai
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, Himeji, Japan.,Division of Cardiovascular Medicine, Department of Exploratory and Advanced Search in Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, Himeji, Japan.,Division of Cardiovascular Medicine, Department of Exploratory and Advanced Search in Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
|
15
|
Dai X, Ni C, Luo W, Miao S, Ma L. Large mural thrombus in the non-aneurysmal and non-atherosclerotic ascending aorta: a case report. J Cardiothorac Surg 2021; 16:200. [PMID: 34301282 PMCID: PMC8299447 DOI: 10.1186/s13019-021-01585-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/11/2021] [Indexed: 11/15/2022] Open
Abstract
Background The mural thrombus in the ascending aorta is rare, most of which are associated with aneurysm or atherosclerotic lesions, with high risks of causing catastrophic thrombotic events. A mural thrombus in the non-aneurysmal and non-atherosclerotic ascending aorta is exceptionally uncommon. Case presentation We reported a large mural thrombus in normal ascending aorta of an asymptomatic patient. Preoperative imaging confirmed the presence of the sessile thrombus located at the left anterior wall of ascending aorta. Given that it had the potential to cause fatal thrombotic complications, surgical removal and segment of ascending aorta replacement were executed. The patient had an uneventful recovery and discharged 14 days after surgery. Conclusions Anticoagulant is the therapeutic cornerstone of ascending aortic thrombus, but surgery should be performed aggressively when the thrombus is large or floating to avoid severe embolic complications or recurrence.
Collapse
Affiliation(s)
- Xiaoyi Dai
- Department of Cardiovascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, Zhejiang, 310003, China.,School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Chengyao Ni
- Department of Cardiovascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Wenzong Luo
- Department of Cardiovascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Sihan Miao
- Department of Cardiovascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, Zhejiang, 310003, China.,School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China
| | - Liang Ma
- Department of Cardiovascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, Zhejiang, 310003, China.
| |
Collapse
|
|
16
|
Frebutte E, Bibombe M, Dumont A, Haxhe M, Reper P. Successful Conservative Treatment of a Complicated Aortic Thrombus in a Woman with Factor V Leiden Mutation. Eur J Case Rep Intern Med 2021; 8:002641. [PMID: 34268269 PMCID: PMC8276923 DOI: 10.12890/2021_002641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/20/2021] [Indexed: 12/04/2022] Open
Abstract
Thrombus in the aortic trunk is a rare complication. We report the case of a 63-year-old patient with a factor V Leiden mutation in whom an aortic arch thrombus was discovered accidentally. Conservative treatment was initiated with therapeutic anticoagulation with low-molecular-weight heparin leading to complete thrombus lysis after 3 months but associated shortly after anticoagulation initiation with a large splenic and limited renal infarctions.
Collapse
Affiliation(s)
- Elise Frebutte
- Internal Medicine Department, CHR Haute Senne, Soignies, Belgium
| | - Myriam Bibombe
- Internal Medicine Department, CHR Haute Senne, Soignies, Belgium
| | - Arthur Dumont
- Internal Medicine Department, CHR Haute Senne, Soignies, Belgium
| | - Maxime Haxhe
- Radiology Department, CHR Haute Senne, Soignies, Belgium
| | - Pascal Reper
- Internal Medicine Department, CHR Haute Senne, Soignies, Belgium.,Critical Care Department, CHR Haute Senne, Soignies, Belgium.,Critical Care Department, CHU UCL Namur, Yvoir, Belgium.,Federal Health Ministry, Brussels, Belgium
| |
Collapse
|
|
17
|
Abstract
A 59-year-old woman with small-cell lung carcinoma achieved tumor disappearance after cisplatin-based chemotherapy (CBC) and radiation treatment but subsequently experienced right hemiparesis and aphasia. Brain magnetic resonance imaging revealed a left middle cerebral artery territory acute infarction and left internal carotid artery occlusion. Ultrasonography revealed a mobile thrombus in the left common and internal carotid arteries, and contrast computed tomography revealed a mural thrombus in the ascending aorta. Based on these findings, embolic stroke due to aortic mural thrombus following CBC was diagnosed. Aortic mural thrombus is a rare complication of CBC but carries a risk of embolic stroke.
Collapse
Affiliation(s)
- Yukiko Ochiai
- Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Japan
| | - Marie Tsunogae
- Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Japan
| | - Masayuki Ueda
- Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Japan
| |
Collapse
|
|
18
|
Chen YY, Yen HT, Wu CC, Huang KR, Sheu JJ, Lee FY. Aortic Thrombus in a Nonaneurysmal Ascending Aorta. Ann Vasc Surg 2020; 72:617-626. [PMID: 33249131 DOI: 10.1016/j.avsg.2020.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ascending aortic thrombus (AAT) in a nonaneurysmal aorta is an extremely rare event and has potentially catastrophic complications, with a life-threatening risk of myocardial infarction and cerebral embolization. This systematic review aims to elucidate the clinical manifestations and to compare the outcomes of anticoagulation therapy versus open aortic surgery for AAT. METHODS The MEDLINE/PubMed databases were extensively searched between 1995 and 2019. All relevant publications on AAT in adults were reviewed, and individual patient data were pooled in this meta-analysis. The primary outcome was AAT resolution. The adverse outcome variables were recurrent arterial embolic events, complications related to open aortic surgery, and mortality during the study period. Chi-squared test and logistic regression analysis were used to compare groups and identify any predictors of mortality. RESULTS Overall, 107 patients from 101 articles were included, of whom 29 patients who received anticoagulation therapy and 59 who underwent open aortic surgery were included in the outcome analysis. Among 29 patients treated with initial anticoagulation therapy, the persistence of AAT was observed in 11 patients (38%) and recurrent arterial embolization was developed in 6 patients (21%). All 11 patients in the anticoagulation group underwent secondary aortic surgery for the persistence of AAT with uneventful postoperative course. Compared with patients treated with primary aortic surgery, patients treated with initial anticoagulation therapy had higher risk of recurrent embolization (P = 0.002). No significant difference existed in the mortality rates between the groups (P = 0.106). Hemodynamic instability was an independent predictor of mortality (P = 0.008). CONCLUSIONS Anticoagulation therapy and open aortic surgery for AAT show similar results; however, open aortic surgery reliably removes AAT and reduces the risk of recurrent embolization compared with anticoagulation therapy. Furthermore, the preoperative hemodynamic status significantly influences the clinical outcome and is a strong predictor of prognosis.
Collapse
Affiliation(s)
- Yen-Yu Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Hsu-Ting Yen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Chen Wu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kwan-Ru Huang
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jiunn-Jye Sheu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fan-Yen Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
|
19
|
Nishimura T, Sueyoshi E, Tasaki Y, Uetani M. Asymptomatic floating thrombus in the ascending aorta depicted on four-dimensional computed tomography. SAGE Open Med Case Rep 2020; 8:2050313X20971894. [PMID: 33224502 PMCID: PMC7649852 DOI: 10.1177/2050313x20971894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022] Open
Abstract
Aortic mural thrombi of the ascending aorta are rare. If an aortic mural thrombus is dislodged, it can cause various embolic complications, which can sometimes be fatal. Although contrast-enhanced computed tomography (CT) and transesophageal echography are useful for diagnosing aortic mural thrombi, four-dimensional CT (4D-CT) is one of the most useful modalities for both diagnosis and treatment selection in such cases. 4D-CT can be used to evaluate the morphology and mobility of thrombi. Furthermore, it is minimally invasive. To the best of our knowledge, there have not been any reports about 4D-CT being used to depict an asymptomatic ascending aortic thrombus. We report a very unusual case, involving an aortic mural thrombus of the ascending aorta.
Collapse
Affiliation(s)
- Takamasa Nishimura
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Eijun Sueyoshi
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yuichi Tasaki
- Department of Cardiovascular Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| |
Collapse
|
|
20
|
Masana M, Martinez LI, Gil M, Bueno G, Llagostera S. Thoracic Aortic Mural Thrombus, Right Ventricular Clot and Pulmonary Embolism in a Patient With COVID-19 Pneumonia. Vasc Endovascular Surg 2020; 55:273-276. [PMID: 33034240 DOI: 10.1177/1538574420966106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Since the outbreak of the COVID-19 pandemic, increasing evidence suggests that infected patients present a high incidence of thrombotic complications. We report a 67-year-old-woman admitted for severe acute respiratory syndrome coronavirus 2 infection. Chest CT images showed bilateral ground glass opacities, bilateral pulmonary embolism, right ventricular clot in transit and 2 thoracic aortic mural thrombus. Therapy was initiated with subcutaneous low-molecular-weight heparin, and the patient was discharged at 20 days asymptomatic. Complete resolution of the aortic thrombus was observed in a 1-month surveillance CT angiogram. Our case illustrates vascular complications in a COVID-19 patient and its effective treatment with anticoagulation.
Collapse
Affiliation(s)
- Marc Masana
- Vascular Surgery Department, 16514Germans Trias I Pujol Hospital, Badalona, Spain
| | - Lucia I Martinez
- Vascular Surgery Department, 16514Germans Trias I Pujol Hospital, Badalona, Spain
| | - Miquel Gil
- Vascular Surgery Department, 16514Germans Trias I Pujol Hospital, Badalona, Spain
| | - Gonzalo Bueno
- Vascular Surgery Department, 16514Germans Trias I Pujol Hospital, Badalona, Spain
| | - Secundino Llagostera
- Vascular Surgery Department, 16514Germans Trias I Pujol Hospital, Badalona, Spain
| |
Collapse
|
|
21
|
Goh SSN, Yong EM, Hong QT, Lo JZ, Chandrasekar S, Ng JJ, Chia YW, Fan EB, Ling LM, Wong PMP, Wee NKX, Punamiya S, Quek HHL, Pua U, Tan GWL. Acute aortic thrombosis presenting as acute limb ischemia in two young, non-atherosclerotic patients. Br J Surg 2020; 107:e565-e566. [PMID: 32776523 DOI: 10.1002/bjs.11897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 12/27/2022]
Affiliation(s)
- S S N Goh
- Department of General Surgery, Tan Tock Seng Hospital
| | - E M Yong
- Department of General Surgery, Tan Tock Seng Hospital
| | - Q T Hong
- Department of General Surgery, Tan Tock Seng Hospital
| | - J Z Lo
- Department of General Surgery, Tan Tock Seng Hospital
| | | | - J J Ng
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital
| | - Y W Chia
- Department of Cardiology, Tan Tock Seng Hospital
| | - E B Fan
- Department of Haematology, Tan Tock Seng Hospital
| | - L M Ling
- Department of Infectious Diseases, National Centre of Infectious Diseases
| | - P M P Wong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - N K X Wee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - S Punamiya
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - H H L Quek
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - U Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital
| | - G W L Tan
- Department of General Surgery, Tan Tock Seng Hospital
| |
Collapse
|
|
22
|
Borghese O, Pisani A, Di Centa I. Symptomatic Aortic Mural Thrombus Treatment and Outcomes. Ann Vasc Surg 2020; 69:373-381. [PMID: 32554193 DOI: 10.1016/j.avsg.2020.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND To report results achieved in treatment of symptomatic aortic mural thrombus in a single institution. MATERIALS AND METHODS A retrospective analysis of data about 97 patients presenting with acute onset lower limb ischemia (Rutherford stage II-III), upper limb ischemia, and mesenteric ischemia surgically treated between January 2011 and December 2018 in the Vascular and Endovascular Unit of Foch Hospital (Suresnes, France) was conducted. Only patients affected with primary aortic mural thrombus (PAMT) as source of embolism were included. RESULTS A total of 9 patients (mean age 51 years, range 28-69; 55.5%, n 5 men and 44.5% n 4 women) were affected with PAMT. Three (33.3%) patients presented a concomitant renal embolism (22.2% of acute renal failure). Thrombus was located at the level of thoracic aorta (4 patients), visceral aorta (2 patients), or infrarenal aorta (3 patients). PAMT was sessile or pedunculated in 5 (55.5%) and 4 (44.4%) patients, respectively. Treatment consisted of anticoagulation in all patients in association with surgical exclusion of the PAMT, distal thrombectomy alone, or in addition to distal bypass. At a median follow-up of 22 months (range 1-57 months) no patients died, 4 patients (44.4%) recovered well, and 5 patients (55.5%) experienced recurrence/thrombus persistency and needed secondary interventions. The best results and absence of recurrences were achieved in patients undergoing immediate exclusion of the PAMT. CONCLUSIONS PAMT is an uncommon source of embolism, and no guidelines are at disposal in its management. An aggressive approach with anticoagulation and exclusion of thrombus seems to be efficacious in preventing recurrences limiting complications and optimizing outcomes.
Collapse
Affiliation(s)
- Ottavia Borghese
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France.
| | - Angelo Pisani
- Department of Cardiovascular Surgery, Bichat-Claude Bernard Hospital, Paris, France
| | - Isabelle Di Centa
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France
| |
Collapse
|
|
23
|
Tsubone S, Fujita A, Ikenaga S. Total arch replacement for the treatment of a giant protruding thrombus in the thoracic aorta derived from an atherosclerotic lesion. Gen Thorac Cardiovasc Surg 2020; 68:1503-1505. [PMID: 32200521 DOI: 10.1007/s11748-020-01340-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/13/2020] [Indexed: 11/27/2022]
Abstract
A thoracic aortic thrombus is rare. The causes of this condition and the feasible options for its treatment remain controversial. Preventing embolic complications are the most important for the management of thoracic aortic thrombi. Herein, we report a case of a giant protruding thrombus in the thoracic aorta. We suggest total arch replacement (TAR) using an open stent graft (OSG) as a favorable management technique for thoracic aortic thrombi. We also recommend bilateral axillary artery cannulation to prevent cerebral infarction.
Collapse
Affiliation(s)
- Sarii Tsubone
- Tokuyama Central Hospital, 1-1 Ko-da chou, Shunan, Yamaguchi, Japan
| | - Akira Fujita
- Tokuyama Central Hospital, 1-1 Ko-da chou, Shunan, Yamaguchi, Japan
| | - Shigeru Ikenaga
- Tokuyama Central Hospital, 1-1 Ko-da chou, Shunan, Yamaguchi, Japan.
| |
Collapse
|
|
24
|
Dalal AR, Kabirpour A, MacArthur JW. Surgical excision of a free floating ascending aortic thrombus. J Card Surg 2019; 35:429-430. [PMID: 31830328 DOI: 10.1111/jocs.14396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND A 73-year-old female presented with leg claudication and chest pain. A mobile mass in the ascending aorta was found. RESULTS The mass was removed through a transverse aortotomy on circulatory arrest via sternotomy. CONCLUSION Free-floating ascending aortic thrombus is a rare source of peripheral embolization. We advocate for emergent surgical resection to prevent further embolization and stroke.
Collapse
Affiliation(s)
- Alex R Dalal
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Armita Kabirpour
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - John W MacArthur
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| |
Collapse
|
|
25
|
Jamjoom R, Zagzoog MM, Sait S. Outcome of Endovascular Approach for Management of Thoracic Aortic Thrombus. Ann Vasc Surg 2019; 59:307.e7-307.e12. [PMID: 31075448 DOI: 10.1016/j.avsg.2019.02.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/21/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022]
Abstract
Thoracic aortic thrombus is a rare condition that can be a significant source of distal embolic events. This study details experience on the use of an endovascular technique for the management of thoracic aortic thrombus with a stent graft in 5 cases. Four of the cases were diagnosed with aortic arch thrombus, and 1 was diagnosed with distal descending aortic thrombus. All patients were females with age ranging from 44 to 71 years. Arterial embolism was the main clinical finding in most cases, which involved the upper extremities (n = 1) and cerebral embolism (n = 3), while 1 patient was asymptomatic. All 5 surgeries were considered technically successful with 0 perioperative all-cause mortality. Patients were discharged in a stable condition and were prescribed anticoagulant and antiplatelet medications. During follow-up visits, there were no instances of stent-graft failure or collapse, leak, or distal migration. Furthermore, there was complete resolution of the intraluminal thrombus, and all patients were asymptomatic.
Collapse
Affiliation(s)
- Reda Jamjoom
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammad M Zagzoog
- Department of Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
| | - Salma Sait
- Department of Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| |
Collapse
|
|
26
|
Tsilimparis N, Spanos K, Debus ES, Rohlffs F, Kölbel T. Technical Aspects of Using the AngioVac System for Thrombus Aspiration From the Ascending Aorta. J Endovasc Ther 2018; 25:550-553. [PMID: 30079784 DOI: 10.1177/1526602818792568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To present the technique for removing mural thrombus from the ascending aorta using the AngioVac System. TECHNIQUE The technique is demonstrated in a 66-year-old woman who presented with free-floating mural thrombus in the ascending aorta and was considered unsuitable for either open (comorbidities) or endovascular approaches (high risk of stroke). Because of the free-floating thrombus, the Angiovac system was suggested, although it is approved for only the venous system. The technique was adapted for the arterial system with the 2 access points being (1) the proximal left subclavian artery with a 10-mm conduit for device access and (2) the right femoral vein. The AngioVac cannula and the reinfusion cannula were inserted into the artery and vein, respectively. The extracorporeal bypass circuit was created, and the carotid arteries were clamped during aspiration (<1 minute). The mural thrombus was aspirated successfully. The patient had an uneventful postoperative course with no signs of free thrombus on the postoperative or follow-up computed tomography angiograms. CONCLUSION The use of the AngioVac System seems to be a feasible technique for aspiration of thrombus from the ascending aorta. Expanding this therapeutic option for patients unsuitable for open or endovascular repair may be proven efficient in the near future.
Collapse
Affiliation(s)
- Nikolaos Tsilimparis
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | - Konstantinos Spanos
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | - E Sebastian Debus
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | - Fiona Rohlffs
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | - Tilo Kölbel
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| |
Collapse
|
|
27
|
A Large Grade 5 Mobile Aortic Arch Atheromatous Plaque: Cause of Cerebrovascular Accident. Case Rep Med 2018; 2018:5134309. [PMID: 29808095 PMCID: PMC5902081 DOI: 10.1155/2018/5134309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 03/04/2018] [Indexed: 12/02/2022] Open
Abstract
Aortic atheromas (aortic atheromatous plaques) are defined by an irregular thickening of the intima ≥2 mm, and a complex plaque is defined as a protruding atheroma ≥4 mm with or without an attached mobile component. Stroke incidence is approximately 25% in patients with mobile plaques of the aortic arch and 2% in patients with quiescent nonmobile plaques. Antiplatelet agents, oral anticoagulants, and statins have been suggested in the management of atheromas. We present an 80-year-old male, with non-ST-segment elevation myocardial infarction (NSTEMI) and chronic dysarthria, found to have an acute cerebrovascular accident (CVA) secondary to embolism from a large 12 mm aortic arch plaque, treated medically with oral antiplatelet therapy, anticoagulation, and statin therapy.
Collapse
|
|
28
|
Khan A, Vasudevan T. Hybrid technique for the management of thoracoabdominal aortic thrombosis and symptomatic Trans-Atlantic Inter-Society Consensus "C" aorto-iliac disease. Vascular 2017; 26:331-334. [PMID: 29022856 DOI: 10.1177/1708538117718645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Thrombotic disease of the thoracic and abdominal aorta co-existing with aorto-iliac disease is a rare clinical association, which poses a great therapeutic challenge and adds to the complexity of the open surgical repair. Method We describe a case of 53-year-old woman with symptomatic thrombus in the thoracic and abdominal aorta down to the aortic bifurcation, which was successfully treated by Thoracic EndoVascular Aortic Repair via the left subclavian artery, open thrombectomy and aorto-iliac bypass. Result Completion angiogram performed through the axillary cannula showed good flow in the aorta, visceral vessels and iliac arteries. Conclusion This hybrid technical approach was a safe and effective strategy to tackle diffuse aortic thrombus with minimal morbidity and visceral embolization. Simultaneous aorto bi iliac bypass with thoracic endovascular aortic repair is a viable approach that can be undertaken with lesser morbidity and mortality risk as compared to complex and highly stressful total open surgical repair.
Collapse
Affiliation(s)
- Aasim Khan
- Department of Vascular and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Thodur Vasudevan
- Department of Vascular and Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
| |
Collapse
|
|
29
|
Meyermann K, Trani J, Caputo FJ, Lombardi JV. Descending thoracic aortic mural thrombus presentation and treatment strategies. J Vasc Surg 2017; 66:931-936. [DOI: 10.1016/j.jvs.2017.05.109] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
|
|
30
|
Riambau V, Böckler D, Brunkwall J, Cao P, Chiesa R, Coppi G, Czerny M, Fraedrich G, Haulon S, Jacobs M, Lachat M, Moll F, Setacci C, Taylor P, Thompson M, Trimarchi S, Verhagen H, Verhoeven E, ESVS Guidelines Committee, Kolh P, de Borst G, Chakfé N, Debus E, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Document Reviewers, Kolh P, Black J, Busund R, Björck M, Dake M, Dick F, Eggebrecht H, Evangelista A, Grabenwöger M, Milner R, Naylor A, Ricco JB, Rousseau H, Schmidli J. Editor's Choice – Management of Descending Thoracic Aorta Diseases. Eur J Vasc Endovasc Surg 2017; 53:4-52. [DOI: 10.1016/j.ejvs.2016.06.005] [Citation(s) in RCA: 862] [Impact Index Per Article: 107.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
|
31
|
Endo H, Ishii H, Tsuchiya H, Takahashi Y, Shimoyamada H, Isomura A, Nakajima M, Hirano T, Ohkura Y, Kubota H. Pathologic Features of Lone Aortic Mobile Thrombus in the Ascending Aorta. Ann Thorac Surg 2016; 102:e313-5. [DOI: 10.1016/j.athoracsur.2016.03.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 03/16/2016] [Accepted: 03/31/2016] [Indexed: 11/28/2022]
|
|
32
|
Kahlberg A, Montorfano M, Cambiaghi T, Bertoglio L, Melissano G, Chiesa R. Endovascular Stent-Grafting of the Ascending Aorta for Symptomatic Parietal Thrombus. J Endovasc Ther 2016; 23:969-972. [PMID: 27530412 DOI: 10.1177/1526602816664877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE To present stent-graft treatment of parietal thrombus in the ascending aorta. CASE REPORT A 64-year-old man with no history of vascular disease developed a right cerebral hemisphere transient ischemic attack and was diagnosed with mural thrombosis of the ascending aorta involving the greater curvature just proximal to the origin of the innominate artery. He was treated for 2 months with anticoagulants, but new imaging studies showed significant increase in the size of the thrombus and an irregular aspect. The thrombus was excluded from the aortic blood flow by deployment of a custom-made stent-graft in the ascending aorta, with embolic protection of the right internal carotid artery. At 6 months, the patient was well, and the thrombus in the ascending aorta appears to be completely excluded by the stent-graft. CONCLUSION In highly selected cases, custom-made thoracic stent-grafts may be used for stabilization and exclusion of symptomatic ascending aorta parietal thrombosis to prevent progression and recurrent embolization.
Collapse
Affiliation(s)
- Andrea Kahlberg
- Department of Vascular Surgery, Scientific Institute H. San Raffaele, Vita Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Department of Interventional Cardiology, Scientific Institute H. San Raffaele, Vita Salute San Raffaele University, Milan, Italy
| | - Tommaso Cambiaghi
- Department of Vascular Surgery, Scientific Institute H. San Raffaele, Vita Salute San Raffaele University, Milan, Italy
| | - Luca Bertoglio
- Department of Vascular Surgery, Scientific Institute H. San Raffaele, Vita Salute San Raffaele University, Milan, Italy
| | - Germano Melissano
- Department of Vascular Surgery, Scientific Institute H. San Raffaele, Vita Salute San Raffaele University, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, Scientific Institute H. San Raffaele, Vita Salute San Raffaele University, Milan, Italy
| |
Collapse
|
|
33
|
Sivakumaran Y, Bullen AS, Leslie GJ. Endovascular stent grafting of a thoracic aortic mobile thrombus with embolic phenomenon. ANZ J Surg 2016; 88:933-935. [PMID: 27102238 DOI: 10.1111/ans.13601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 02/22/2016] [Accepted: 03/07/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Yogeesan Sivakumaran
- Department of Surgery, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
| | - Andrew S Bullen
- Department of Vascular Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Gregory J Leslie
- Department of Surgery, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia.,Department of Vascular Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia.,School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| |
Collapse
|
|
34
|
Weiss S, Bühlmann R, von Allmen RS, Makaloski V, Carrel TP, Schmidli J, Wyss TR. Management of floating thrombus in the aortic arch. J Thorac Cardiovasc Surg 2016; 152:810-7. [PMID: 27160939 DOI: 10.1016/j.jtcvs.2016.03.078] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/20/2016] [Accepted: 03/28/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Floating aortic thrombus is an underrecognized source of systemic emboli and carries a life-threatening risk of stroke when located in the aortic arch. Optimal treatment is not established in available guidelines. We report our experience in managing floating thrombi in the aortic arch. METHODS Consecutive patients diagnosed with a floating aortic arch thrombus at a tertiary referral center between January 2008 and December 2014 were reviewed. Perioperative and midterm outcomes were assessed. RESULTS Ten patients (8 female) with a median age of 56 years (range, 47-82 years) were identified. Eight patients presented with a symptomatic embolic event, and 2 patients were asymptomatic. One patient presenting with stroke due to embolic occlusion of all supra-aortic vessels died 2 days after admission. Three patients (2 asymptomatic and 1 unfit for surgery) were treated conservatively by anticoagulation, leading to thrombus resolution in 2 patients. In the third patient, the thrombus persisted despite anticoagulation, resulting in recurrent embolic events. The remaining 6 patients underwent open thrombectomy of the aortic arch during deep hypothermic circulatory arrest. All patients treated by surgery had an uneventful postoperative course with no recurrent thrombus or embolic event during follow-up. Median follow-up of all patients was 17 months (range, 11-89 months). CONCLUSIONS Floating aortic arch thrombus is a dangerous source of systemic emboli. Surgical removal of the thrombus is easy to perform and followed by good clinical results. Conservative treatment with anticoagulation may be considered in asymptomatic, inoperable or high-risk patients.
Collapse
Affiliation(s)
- Salome Weiss
- Clinic of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roman Bühlmann
- Clinic of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Regula S von Allmen
- Clinic for Vascular Surgery, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Vladimir Makaloski
- Clinic of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thierry P Carrel
- Clinic of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jürg Schmidli
- Clinic of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Clinic of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
|
35
|
Ostertag-Hill CA, Titus JM, Skeik N. A Unique Case of Aortic Thrombosis With Elevated Lipoprotein(a). Vasc Endovascular Surg 2016; 50:286-9. [DOI: 10.1177/1538574416642875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aortic thrombosis is a rare condition that can be caused by atherosclerosis, aneurysms, thrombophilia, vasculitis, trauma, and malignancy. Symptoms vary based on thrombus size and site of embolization. It can lead to devastating complications including acute limb ischemia, myocardial infarction, stroke, and other target organ ischemia. Diagnosis is based on clinical presentation, imaging findings, and relevant laboratory work-up. Although not well defined, management for aortic thrombosis includes surgical intervention, such as thromboembolectomy, and conservative measures, such as anticoagulation. Here, we present a unique case of aortic thrombosis causing acute lower limb ischemia with elevated lipoprotein(a) and other comorbidities. Based on our literature review, our article is the first to establish the connection between elevated lipoprotein(a) and aortic thrombosis in the nonaneurysmal aorta.
Collapse
Affiliation(s)
| | - Jessica M. Titus
- Vascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN
| | - Nedaa Skeik
- Vascular Medicine Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN
| |
Collapse
|
|
36
|
Manlove W, Raptis CA, Bhalla S. Pitfalls in computed tomography of the aorta. Semin Roentgenol 2015; 50:229-34. [PMID: 26002244 DOI: 10.1053/j.ro.2015.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Whitney Manlove
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO.
| |
Collapse
|
|
37
|
Abissegue YG, Lyazidi Y, Chtata H, Bakkali T, Taberkant M. Acute systemic embolism due to an idiopathic floating thrombus of the thoracic aorta: success of medical management: a case report. BMC Res Notes 2015; 8:181. [PMID: 25933802 PMCID: PMC4427991 DOI: 10.1186/s13104-015-1149-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/23/2015] [Indexed: 11/17/2022] Open
Abstract
Background Idiopathic thoracic aortic mural thrombi are rare. They can be responsible for dramatic systemic embolization. Early treatment is imperative because of their high morbidity and mortality rate. Case presentation A 55-year-old previously healthy Moroccan male came in an array of acute right lower limbs pain and abdominal sensibility. Severe systemic embolism involving the lower extremities, spleen, kidney, and digestive tract, due to an idiopathic mural thrombus of the thoracic aorta was diagnosed. He received medical treatment leading to the complete disappearance of the thrombus and the effects caused by the latter. Conclusions When faced unexplained peripheral embolization, research for a thrombus of the thoracic aorta should be performed. Medical treatment should be considered for its management, especially in patients with high surgical risk.
Collapse
Affiliation(s)
- Yves Ghislain Abissegue
- Department of Vascular Surgery, Mohammed V Military Hospital, Mohammed V University, Dr Abissegue Yves S/C ERSSM BP 1044 Rabat Océan Maroc, Rabat, Morocco.
| | - Youssef Lyazidi
- Department of Vascular Surgery, Mohammed V Military Hospital, Mohammed V University, Dr Abissegue Yves S/C ERSSM BP 1044 Rabat Océan Maroc, Rabat, Morocco.
| | - Hassan Chtata
- Department of Vascular Surgery, Mohammed V Military Hospital, Mohammed V University, Dr Abissegue Yves S/C ERSSM BP 1044 Rabat Océan Maroc, Rabat, Morocco.
| | - Tarik Bakkali
- Department of Vascular Surgery, Mohammed V Military Hospital, Mohammed V University, Dr Abissegue Yves S/C ERSSM BP 1044 Rabat Océan Maroc, Rabat, Morocco.
| | - Mustapha Taberkant
- Department of Vascular Surgery, Mohammed V Military Hospital, Mohammed V University, Dr Abissegue Yves S/C ERSSM BP 1044 Rabat Océan Maroc, Rabat, Morocco.
| |
Collapse
|
|
38
|
Dhillon P, Murdoch D, Jayasinghe R, Niranjan S. A Case of Mobile Aortic Arch Thrombus with Systemic Embolisation—A Management Dilemma. Heart Lung Circ 2014; 23:e88-91. [DOI: 10.1016/j.hlc.2013.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 08/09/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
|
|
39
|
Thoracic endovascular aortic repair in a patient with mobile aortic thrombosis. Case Rep Vasc Med 2014; 2014:302346. [PMID: 24716094 PMCID: PMC3971888 DOI: 10.1155/2014/302346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 01/01/2014] [Indexed: 11/17/2022] Open
Abstract
A 58-year-old female presented with acute arterial insufficiency to her left leg. Following cardiovascular evaluation using multimodality imaging, it was discovered that she had mobile thoracic thrombi overlying a normal descending thoracic aorta which had also caused a splenic infarction. This patient was treated with unfractionated heparin for three days and underwent subsequent thoracic endovascular aortic repair (TEVAR) uneventfully with no subsequent complications at one-year followup. This case highlights the diagnostic and therapeutic challenges in treating patients with this uncommon challenging clinical scenario.
Collapse
|
|
40
|
Yoshikawa Y, Kamikubo Y, Sonoda H, Yamakage M. Unexpectedly resolved multiple mobile thrombi in a normal thoracic aorta associated with colorectal cancer and protein C deficiency. J Cardiothorac Vasc Anesth 2013; 28:714-7. [PMID: 23627996 DOI: 10.1053/j.jvca.2012.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Yusuke Yoshikawa
- Division of Anesthesia, Kushiro City General Hospital, Kushiro, Japan.
| | - Yasuhiro Kamikubo
- Division of Anesthesia, Kushiro City General Hospital, Kushiro, Japan
| | - Hajime Sonoda
- Division of Anesthesia, Kushiro City General Hospital, Kushiro, Japan
| | - Michiaki Yamakage
- Division of Anesthesia, Kushiro City General Hospital, Kushiro, Japan
| |
Collapse
|
|
41
|
Bare Metal Stenting for Endovascular Exclusion of Aortic Arch Thrombi. Cardiovasc Intervent Radiol 2013; 36:1127-31. [DOI: 10.1007/s00270-013-0566-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 12/26/2012] [Indexed: 11/25/2022]
|
|
42
|
Timek TA, Alguire CT, Wolschleger KG, Chung MH. Aortic root thrombosis after transhiatal esophagectomy: a case report. J Thorac Cardiovasc Surg 2012; 145:e14-6. [PMID: 23141033 DOI: 10.1016/j.jtcvs.2012.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/22/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Tomasz A Timek
- Meijer Heart and Vascular Institute, Grand Rapids Medical Education Partners, Grand Rapids, Mich 49503, USA.
| | | | | | | |
Collapse
|