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Nguyen Q, Ma X, Vervoort D, Luc JGY. Management Strategies for Descending Thoracic Aortic Thrombus: A Review of the Literature. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:283-296. [PMID: 35866207 PMCID: PMC9403384 DOI: 10.1177/15569845221107011] [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] [Indexed: 12/04/2022]
Abstract
Descending thoracic aortic thrombus (DTAT) is an under-recognized source of
systemic emboli with potential catastrophic consequences. Imaging modalities
such as echocardiography, computed tomography, magnetic resonance imaging, and
angiography can help identify and characterize the extent of embolic events.
Established guidelines regarding the management of DTAT are currently lacking.
Multiple treatment modalities are available; however, the effectiveness of each
approach remains to be determined. In this study, we performed a review to
examine the clinical presentation, diagnostic methods and findings, and outcomes
of various treatment options for patients with DTAT. Medical management is the
least invasive and most frequently chosen initial approach, offering a high
reported success rate, whereas endovascular therapy can have a role in thrombus
exclusion should conservative management fail.
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Affiliation(s)
- Quynh Nguyen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Xiya Ma
- Faculty of Medicine, Université de Montréal, QC, Canada
| | - Dominique Vervoort
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, ON, Canada
| | - Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, 8166University of British Columbia, Vancouver, BC, Canada
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2
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Martins APD, Bertolucci LH, Warpechowski RB, Angonese A, Azevedo MSD, Rodrigues C, Schulte AA, Perini SC. Mobile thrombus of the abdominal aorta: a narrative review. J Vasc Bras 2022; 21:e20220028. [PMID: 36187217 PMCID: PMC9477479 DOI: 10.1590/1677-5449.202200282] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
A primary aortic mural thrombus (PAMT) is defined as a thrombus attached to the aortic wall in the absence of any atherosclerotic or aneurysmal disease of the aorta or any cardiac source of embolus. It is a rare entity that has high morbidity and mortality. There is no consensus on the ideal treatment of PAMT. The objective of this paper is to review the possibilities for treatment of mobile abdominal aortic mural thrombus. Endovascular therapy and open surgery appear to be the best options for treatment of mobile abdominal aortic mural thrombus. Thus, in patients with favorable anatomy, endovascular therapy is probably the treatment choice, while in those with unfavorable anatomy, open surgery is probably the best option for treatment of a mobile abdominal aortic thrombus. It is important to emphasize that anticoagulation alone can be used as a non-aggressive option and, if this fails, endovascular or surgical methods can then be employed.
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Affiliation(s)
| | | | | | - Arthur Angonese
- Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
| | | | | | | | - Silvio Cesar Perini
- Pontifícia Universidade Católica do Rio Grande do Sul, Brasil; Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
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3
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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: 2] [Impact Index Per Article: 0.7] [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.
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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
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Goedemé J, Berzenji L, Nicolay S, Hendriks JM. Conservative Treatment of a Floating Mural Thrombus in the Descending Aorta. AORTA (STAMFORD, CONN.) 2021; 9:38-40. [PMID: 34607384 PMCID: PMC8489990 DOI: 10.1055/s-0041-1736370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/02/2020] [Indexed: 12/03/2022]
Abstract
A 70-year-old woman was referred to the department of thoracic and vascular surgery after a floating mural thrombus was found in the distal aortic arch with extension into the proximal descending aorta. Imaging and clinical examination did not show signs of embolization and treatment with aspirin and low-molecular weight heparin was started. Follow-up after 2 weeks and 6 months showed a complete resolution of the aortic mural thrombus.
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Affiliation(s)
- Johannes Goedemé
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Lawek Berzenji
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Simon Nicolay
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Jeroen M.H. Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
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5
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Chennakeshavallu GN, Sankar S. Intraoperative transesophageal echocardiographic detection of large mobile aortic thrombus in a patient with iron deficiency anemia presenting as acute limb ischemia. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_171_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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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: 3] [Impact Index Per Article: 0.8] [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.
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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
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7
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Murter CD, Sigdel A, Dwivedi AJ, Wayne EJ. Percutaneous thrombectomy of mural aortic thrombus using intravascular ultrasound guidance. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:472-476. [PMID: 31763501 PMCID: PMC6859285 DOI: 10.1016/j.jvscit.2019.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/24/2019] [Indexed: 11/24/2022]
Abstract
Mural aortic thrombus is a challenging clinical problem with significant potential complications. Particularly precarious are situations with involvement of the visceral segment of the aorta. We describe a technique for percutaneous thrombectomy of mural aortic thrombus using intravascular ultrasound to guide an angled mechanical thrombectomy catheter in conjunction with a continuous aspiration system (Indigo mechanical thrombectomy system; Penumbra, Alameda, Calif). Use of this technique in three patients with challenging cases of mural aortic thrombus is discussed. All patients were treated successfully and without complication using this technique.
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Affiliation(s)
- Christopher D Murter
- Division of Vascular and Endovascular Surgery, University of Louisville, Louisville, Ky
| | - Abindra Sigdel
- Division of Vascular and Endovascular Surgery, University of Louisville, Louisville, Ky
| | - Amit J Dwivedi
- Division of Vascular and Endovascular Surgery, University of Louisville, Louisville, Ky
| | - Erik J Wayne
- Division of Vascular and Endovascular Surgery, University of Louisville, Louisville, Ky
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8
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Yagyu T, Naito M, Kumada M, Nakagawa T. Aortic Mural Thrombus in the Non-atherosclerotic Aorta of Patients with Multiple Hypercoagulable Factors. Intern Med 2019; 58:381-385. [PMID: 30210102 PMCID: PMC6395124 DOI: 10.2169/internalmedicine.0691-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
An aortic mural thrombus (AMT) on a non-atherosclerotic wall is a rare but important cause of arterial thromboembolism. We herein report two cases of AMT in the thoracic aorta. Both showed multiple hypercoagulable factors (case 1: protein S deficiency and positive finding of anti-cardiolipin antibody; case 2: protein C deficiency, gastric cancer, and cisplatin-based chemotherapy) and were successfully treated with anticoagulation. Hypercoagulable states, including malignancy, can influence the formation of AMT; therefore, the accurate assessment of a hypercoagulable condition is necessary when we encounter patients with AMT.
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Affiliation(s)
- Takeshi Yagyu
- Department of Cardiology, Toyonaka Municipal Hospital, Japan
| | - Maiko Naito
- Department of Cardiology, Toyonaka Municipal Hospital, Japan
| | - Masahiro Kumada
- Department of Cardiology, Toyonaka Municipal Hospital, Japan
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9
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Mirza AK, Saran N, Warrington KJ, Pochettino A, Shuja F. Isolated Thoracic Aortic Takayasu Arteritis Presenting as Presumed Mobile Aortic Thrombus. Vasc Endovascular Surg 2019; 53:267-270. [PMID: 30606091 DOI: 10.1177/1538574418823389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Isolated aortic mural thrombus (AMT) is an infrequent occurrence in the setting of an otherwise normal aorta and is a similarly rare occurrence in Takayasu arteritis (TAK). As such, consensus on optimal treatment strategy does not exist, however, invariably necessitates anticoagulation. We report a case of a 21-year-old female who presented with acute chest pain with an isolated descending thoracic AMT on imaging. Diagnosis was elusive after an exhaustive, multidisciplinary evaluation including structural, hypercoagulable, and rheumatologic etiologies. After hypertension control and anticoagulation, she was asymptomatic without embolic sequelae. We proceeded with thoracic aortic resection with interposition reconstruction for the dual function of treatment and definitive diagnosis revealing TAK. This demonstrates a curious presentation of TAK with an equally atypical complication managed with surgery.
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Affiliation(s)
- Aleem K Mirza
- 1 Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Nishant Saran
- 2 Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Fahad Shuja
- 1 Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
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10
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Aortic Arch Floating Thrombus Complicated by Distal Embolization in a Patient with Malignancy. Case Rep Vasc Med 2018; 2018:2040925. [PMID: 30370154 PMCID: PMC6189665 DOI: 10.1155/2018/2040925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/16/2018] [Indexed: 12/27/2022] Open
Abstract
Free floating thrombus of aortic arch in a minimally atherosclerotic or nonaneurysmal aorta is a rare disease entity which carries a potential risk of distal embolization with catastrophic consequences. We present the case of a 52-years-old patient with ovarian cancer and aortic arch floating thrombus who initially managed with low molecular weight heparin and eventually undergone surgical thrombectomy of left external iliac and common femoral artery due to acute ischemia of left lower leg.
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11
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Kandemirli SG, Balkanay OO, Awiwi MO, Durmaz E, Goksedef D, Comunoglu N. Thoracoabdominal aortic mural and floating thrombus extending into superior mesenteric artery. J Med Ultrason (2001) 2017; 45:539-542. [PMID: 29236196 DOI: 10.1007/s10396-017-0848-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/09/2017] [Indexed: 11/28/2022]
Abstract
Thrombus in the thoracic aorta not related to aneurysm or atherosclerosis is a rare clinical entity with a limited number of cases reported. Floating thrombus is defined as non-adherent part of the thrombus floating within the aortic lumen. Herein, we present a 48-year-old woman who presented with progressive midline dull, aching abdominal pain of 2-day duration. Thoracoabdominal computed tomography revealed a free floating thrombus extending from the aortic arch into the superior mesenteric artery. Transesophageal echocardiography confirmed the findings of a thrombus extending through the aortic arch. Floating thrombus within the aortic lumen in a morphologically normal descending thoracic and abdominal aorta is a rare entity.
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Affiliation(s)
- Sedat Giray Kandemirli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Fatih, 34098, Istanbul, Turkey.
| | - Ozan Onur Balkanay
- Department of Cardiovascular Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Muhammad Osama Awiwi
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Fatih, 34098, Istanbul, Turkey
| | - Eser Durmaz
- Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Deniz Goksedef
- Department of Cardiovascular Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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12
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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: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
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13
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Karaolanis G, Moris D, Bakoyiannis C, Tsilimigras DI, Palla VV, Spartalis E, Schizas D, Georgopoulos S. A critical reappraisal of the treatment modalities of normal appearing thoracic aorta mural thrombi. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:306. [PMID: 28856146 DOI: 10.21037/atm.2017.05.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mural thrombus in non-atherosclerotic or aneurysmatic thoracic aorta is a relatively uncommon entity. Currently there is no consensus on the appropriate therapeutic algorithm of its management. We aim to present the current knowledge on the treatment of thoracic aorta mural thrombi (TAMT) in minimally atherosclerotic vessels and we hope that the juxtaposed discussions will shed light on the uncharted waters regarding this rare syndrome. The MEDLINE/PubMed database was searched for publications with the medical subject "aortic mural thrombus" and keywords "thoracic", "embolism", "normal vessel", "minimally atherosclerotic vessel" or "treatment". We restricted our search to English language, till January 2017. The electronic literature search yielded 23 reports that were deemed appropriate for further analysis. Anticoagulation is the standard of care for the treatment of the thrombus whereas surgical and interventional treatment seems to be related with increased mortality and lower recurrence rates. TAMT treatment is controversial. Anticoagulants are the mainstay of treatment but surgery seems to gain ground in several settings as an only therapy or a combined treatment modality. More data are needed on the role of novel oral anticoagulants and endografts.
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Affiliation(s)
- Georgios Karaolanis
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Demetrios Moris
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Chris Bakoyiannis
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Diamantis I Tsilimigras
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Viktoria-Varvara Palla
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Eleftherios Spartalis
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Sotirios Georgopoulos
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
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14
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Jonák M, Majchrák O, Novotný J, Ternuscsák O. Endovascular treatment of the malignant thrombus in the descending thoracic aorta. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Chong BK, Mun D, Kang CH, Park CB, Cho WC. Essential Thrombocytosis-Associated Thromboembolism in the Abdominal Aorta. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2016; 49:397-400. [PMID: 27734003 PMCID: PMC5059129 DOI: 10.5090/kjtcs.2016.49.5.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 11/24/2022]
Abstract
Essential thrombocytosis (ET) is a myeloproliferative disorder characterized by an anomalous increase in platelet production. Many patients with ET are asymptomatic. Few studies have reported ET-associated thromboembolism in large vessels such as the aorta. We report a patient with ET who presented with peripheral embolism from an abdominal aortic thrombus and developed acute limb ischemia. The patient underwent aortic replacement successfully. The patient’s platelet count was controlled with hydroxyurea, and no recurrence was noted over 2 years of follow-up.
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Affiliation(s)
- Byung Kwon Chong
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Dana Mun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Chae Hoon Kang
- Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine
| | - Chong-Bin Park
- Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine
| | - Won Chul Cho
- Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine
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16
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Endovascular Treatment of Symptomatic Thrombus of the Descending Thoracic Aorta. Ann Vasc Surg 2016; 36:295.e13-295.e16. [DOI: 10.1016/j.avsg.2016.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 03/22/2016] [Indexed: 11/17/2022]
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17
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Vázquez Dopazo R, Fernández Noya J, Méndez Fernández A, Silva González O, Coraizaca Chicaiza N. Stent temporal para la prevención de embolismos distales en el tratamiento endovascular de las lesiones de la aorta torácica. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2014.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Elective Stent-graft Treatment for the Management of Thoracic Aorta Mural Thrombus. Eur J Vasc Endovasc Surg 2014; 47:335-41. [DOI: 10.1016/j.ejvs.2013.11.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 11/27/2013] [Indexed: 11/19/2022]
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19
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Endovascular strategies for treatment of embolizing thoracoabdominal aortic lesions. J Vasc Surg 2014; 59:1256-64. [PMID: 24433783 DOI: 10.1016/j.jvs.2013.11.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 11/14/2013] [Accepted: 11/18/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Aortic sources of peripheral and visceral embolization remain challenging to treat. The safety of stent graft coverage continues to be debated. This study reports the outcomes of stent coverage of these complex lesions. METHODS Hospital records were retrospectively reviewed for patients undergoing aortic stenting between 2006 and 2013 for visceral and peripheral embolic disease. Renal function, method of coverage, and mortality after stent grafting were reviewed. RESULTS Twenty-five cases of embolizing aortic lesions treated with an endovascular approach were identified. The mean age was 65 ± 13 years (range, 45-87 years), and 64% were female. Sixteen (64%) patients presented with peripheral embolic events, six with concomitant renal embolization. Five patients presented with abdominal or flank pain, and two were discovered incidentally. Three patients had undergone an endovascular procedure for other indications within the preceding 6 months of presentation. Nineteen patients had existing chronic kidney disease (stage II or higher), but only three had stage IV disease. Of the eight patients tested, four had a diagnosed hypercoagulable state. Eight of the patients had lesions identified in multiple aortic segments, and aortic aneurysm disease was present in 24%. Coverage of both abdominal and thoracic sources occurred in eight patients, whereas 17 had only one segment covered. Minimal intraluminal catheter and wire manipulation was paired with the use of intravascular ultrasound in an effort to reduce embolization and contrast use. Intravascular ultrasound was used in the majority of cases and transesophageal echo in 28% of patients. Two patients with stage IV kidney disease became dialysis-dependent within 3 months of the procedure. No other patients had an increase in their postoperative or predischarge serum creatinine levels. No embolic events were precipitated during the procedure, nor were there any recurrent embolic events detected on follow-up. The 1-year mortality rate was 25%. CONCLUSIONS Endovascular coverage of atheroembolic sources in the aorta is feasible and is safe and effective in properly selected patients. It does not appear to worsen renal function when performed with the use of specific technical strategies.
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20
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Scott DJ, White JM, Arthurs ZM. Endovascular management of a mobile thoracic aortic thrombus following recurrent distal thromboembolism: a case report and literature review. Vasc Endovascular Surg 2013; 48:246-50. [PMID: 24347279 DOI: 10.1177/1538574413513845] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sources of lower extremity and visceral arterial thromboembolism most commonly include the heart and proximal aneurysmal disease. Infrequently, further workup of "cryptogenic" emboli will reveal a mural atheroma or thrombus of the descending thoracic aorta. Without prospective data, anticoagulation and open surgical thrombectomy with or without aortic replacement have been the standard approach. Presented is a case of a floating mural thrombus in the setting of superior mesenteric and femoral arterial thromboembolism that was effectively treated with endovascular stent graft exclusion.
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Affiliation(s)
- Daniel J Scott
- Department of Vascular Surgery, San Antonio Military Medical Center, Ft Sam Houston, TX, USA
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21
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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: 0.4] [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
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22
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Yun WS, Lee KK, Cho J, Kim HK, Huh S. Treatment outcome in patients with acute superior mesenteric artery embolism. Ann Vasc Surg 2013; 27:613-20. [PMID: 23540675 DOI: 10.1016/j.avsg.2012.07.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 06/18/2012] [Accepted: 07/08/2012] [Indexed: 02/08/2023]
Abstract
PURPOSE The goals of this study were to investigate the treatment outcomes of acute mesenteric ischemia caused by superior mesenteric artery (SMA) embolism and identify the posttreatment prognostic factors. METHODS The clinical data of 32 episodes of acute SMA embolism in 30 patients, including 2 recurrent cases, between April 2003 and March 2011 were retrospectively reviewed. RESULTS Median patient age was 74 years (range, 39-89 years), and 50% were male. Conservative treatment, including bowel rest, nasogastric drainage, intravenous fluid therapy, parenteral nutritional support, and anticoagulation therapy, was undertaken in 5 patients with no clinical evidence of bowel gangrene, including 1 with recurrent ischemia. No deaths occurred among patients treated conservatively. A total of 27 patients were treated with open surgical repair (25 embolectomies and 2 bowel resections alone). Among 25 patients treated with embolectomy, 14 required bowel resection. Most bowel resections (94%, 15/16) were limited, with the remaining length of small bowel greater than 150 cm, which could not cause short bowel syndrome. In-hospital mortality of surgery was 30%. No variables were associated with mortality after surgical intervention, including, age, gender, presence of bowel gangrene, and symptom duration. The overall 1-, 3-, and 5-year survival rates after initial successful treatment were 96%, 73%, and 44%, respectively, regardless of treatment type. CONCLUSIONS Prompt diagnosis and treatment before extensive irreversible gangrene is the mainstay in the treatment of SMA embolism. Limited bowel gangrene was not associated with mortality.
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Affiliation(s)
- Woo-Sung Yun
- Division of Vascular/Endovascular Surgery, Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
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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: 0.9] [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]
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24
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Willson TD, Rao V, Podbielski FJ, Blecha MJ. In situ aortic thrombosis secondary to intra-abdominal abscess. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:149-52. [PMID: 23569514 PMCID: PMC3616123 DOI: 10.12659/ajcr.883244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 05/10/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Abdominal aortic mural thrombus is uncommon in the absence of aneurysm or atherosclerosis. CASE REPORT We report the case of a 46-year-old man who presented to our institution with perforated appendicitis for which he initially declined surgery. Four days after admission he ultimately consented to appendectomy and abdominal washout. Follow-up imaging to evaluate for intra-abdominal abscess revealed mural thrombus of the infra-renal abdominal aorta extending into the left iliac artery. This thrombus was not present on the admission CT scan. The patient had no clinical signs of limb ischemia. Conservative treatment with therapeutic anticoagulation resulted in resolution of the thrombus. CONCLUSIONS While portal, mesenteric, and major retroperitoneal venous thrombosis are well associated with major intra-abdominal infection and inflammatory bowel disease, aorto-iliac arterial thrombus formation in the absence of associated aneurysm, atherosclerosis or embolic source is exceedingly rare. We are unaware of other reports of in-situ aorto-iliac arterial thrombus formation secondary to perforated appendicitis.
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25
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Morris ME, Galiñanes EL, Nichols WK, Ross CB, Chauvupun J. Thoracic mural thrombi: a case series and literature review. Ann Vasc Surg 2012; 25:1140.e17-21. [PMID: 22023948 DOI: 10.1016/j.avsg.2011.05.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 05/02/2011] [Accepted: 05/03/2011] [Indexed: 11/24/2022]
Abstract
Thoracic mural thrombi (TMT) are rare but an important source of distal emboli. Treatment options are dynamic, ranging from open, endovascular to conservative therapies. We report two cases of TMT, one successfully treated with thoracic aortic endoluminal stent placement for visceral and peripheral embolization, the second treated conservatively for digital embolization secondary to TMT in the innominate artery.
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26
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Thrombus in the Non-aneurysmal, Non-atherosclerotic Descending Thoracic Aorta – An Unusual Source of Arterial Embolism. Eur J Vasc Endovasc Surg 2011; 41:450-7. [DOI: 10.1016/j.ejvs.2010.11.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 11/04/2010] [Indexed: 11/18/2022]
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27
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Krüger T, Liske B, Ziemer S, Lindemann S, Ziemer G. Thrombolysis to Treat Thrombi of the Aortic Arch. Clin Appl Thromb Hemost 2010; 17:340-5. [DOI: 10.1177/1076029610364519] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thoracic mobile aortic mural thrombus (TAMT) of the aortic arch is a rare condition. We report 3 cases of symptomatic TAMT treated with systemic alteplase (tissue plasminogen activator [t-PA]) thrombolysis. The first patient was symptomatic with repetitive thromboembolism to the left brachial artery. She was treated with repetitive thrombolysis after surgical embolectomy of the brachial artery. The second patient was symptomatic with splenic infarction and mesenteric ischemia. She was treated with a single cycle of systemic thrombolysis followed by ileocoecal resection. The third patient presented with a TAMT obstructing the left common carotid artery, causing ischemic stroke. After systemic thrombolysis, a reduction in thrombus size was documented; however, the patient died later, of acute heart failure, during the clinical course. On follow-up 6 months after the incidences, the 2 surviving patients were in good condition and free of thromboembolic events. We show that systemic thrombolytic therapy can be performed successfully in patients with TAMT.
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Affiliation(s)
- Tobias Krüger
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital of Tübingen, Germany,
| | - Benjamin Liske
- Department of Neurology, University Hospital of Tübingen, Germany
| | - Sabine Ziemer
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital of Tübingen, Germany
| | | | - Gerhard Ziemer
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital of Tübingen, Germany
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Catapano Minotti G, Corsonello A, Guadalupi G, Antonelli Incalzi R. A thrombotic snake in the thoracic aorta. Intern Emerg Med 2009; 4:515-6. [PMID: 19629640 DOI: 10.1007/s11739-009-0288-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 07/02/2009] [Indexed: 11/24/2022]
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29
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Floating aortic arch thrombus involving the supraaortic trunks: Successful treatment with supra-aortic debranching and antegrade endograft implantation. J Vasc Surg 2009; 50:1177-80. [DOI: 10.1016/j.jvs.2009.05.052] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 04/17/2009] [Accepted: 05/20/2009] [Indexed: 11/19/2022]
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30
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Morata Barrado PC, Blanco Cañibano E, García Fresnillo B, Guerra Requena M. Acute lower limb ischemia in a patient with aortic thrombus and essential thrombocytosis. Int J Hematol 2009; 90:343-346. [DOI: 10.1007/s12185-009-0394-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 07/06/2009] [Accepted: 07/14/2009] [Indexed: 01/04/2023]
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