Elective Stent-graft Treatment for the Management of Thoracic Aorta Mural Thrombus
Elective Stent-graft Treatment for the Management of Thoracic Aorta Mural Thrombus
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DOI：
10.1016/j.ejvs.2013.11.014
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发表时间：
2014-04-01
影响因子：
5.7
通讯作者：
Alimi, Y. S.
中科院分区：
文献类型：
--
作者：
Boufi, M.;Memeli, A.;Alimi, Y. S.
背景：主动脉附壁血栓（AMT）的最佳治疗仍然存在争议。本研究的目的是描述AMT的管理在胸主动脉与保守或覆膜支架治疗，并分析血栓的形态学特征的作用，在选择合适的候选人intervention.Methods：回顾性分析所有患者入院胸AMT。记录临床数据、所用治疗和结局。根据所用治疗将患者分为两组：保守治疗或覆膜支架治疗。结果：从2006年1月至2013年3月，连续13例患者（9例男性，平均年龄53岁，范围37-76岁）因症状性AMT（n = 8）或无症状性AMT（n = 5）入院。所有患者均接受普通肝素治疗。原发性主动脉血栓的治疗需要7例患者的覆膜支架，1例患者的主动脉血栓切除术，5例患者仅接受抗凝治疗。干预适应症为复发性栓塞（n = 4）、肝素治疗下发生栓塞（n = 1）或持续性血栓（n = 2）。所有病例的AMT血管内隔绝术均成功，30天时无并发症或死亡，中期无复发。血栓的形态学特征分析仅确定了与不良结局相关的高度流动性（p = 0.048）。结论：根据我们的经验，AMT的覆膜支架排斥是一种有效的方法。通过实时成像研究系统评价血栓移动性有助于更好地确定主动脉病变根治性治疗的指征。(C)2013年欧洲血管外科学会。由爱思唯尔有限公司出版。保留所有权利。
Background: Optimal management of aorta mural thrombus (AMT) continues to be controversial. The aim of this study was to describe the management of AMT in the thoracic aorta with either conservative or stentgraft treatment and to analyze the role of morphological characteristics of thrombus in the selection of suitable candidates for intervention.Methods: A retrospective review was conducted of all patients admitted for thoracic AMT. Clinical data, treatment used, and outcomes were recorded. Patients were divided in two groups according to the treatment used: either conservative or stentgraft. Morphological features of thrombus, including size, sessile or pedunculated aspect and mobility, were compared between the two groups.Results: From January 2006 to March 2013,13 consecutive patients (nine male, mean age 53, range 37-76) were admitted for symptomatic (n = 8) or asymptomatic AMT (n = 5). All patients received unfractionated heparin. Management of primary aortic thrombus required stentgraft in seven patients, aortic thrombectomy in one, and anticoagulation therapy alone in five. Indications for intervention were recurrent embolism (n = 4), occurrence of embolism under heparin (n = 1), or persistent thrombus (n = 2). Endovascular exclusion of AMT was successful in all cases, with no complications or deaths at 30 days and no recurrence at midterm. Analysis of the morphological features of the thrombus identified solely the high degree mobility as associated with adverse outcome (p = .048).Conclusion: In our experience, stentgraft exclusion of AMT is an effective approach. Systematic evaluation of thrombus mobility by a real-time imaging study can be helpful to better define the indications for radical treatment of the aortic lesion. (C) 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.