Anticoagulation is an effective treatment for aortic mural thrombi
Anticoagulation is an effective treatment for aortic mural thrombi
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DOI：
10.1067/mva.2002.127968
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发表时间：
2002-10-01
影响因子：
4.3
通讯作者：
Hood, DB
中科院分区：
文献类型：
--
作者：
Bowdish, ME;Weaver, FA;Hood, DB
背景主动脉壁血栓（AMT）在没有主动脉疾病是罕见的。手术血栓切除术、溶栓和全身抗凝治疗的适应症和疗效仍存在争议。本研究在一个学术医学中心进行，回顾性分析了1997年至2001年间接受治疗的5例无主动脉疾病的AMT患者。主要结果的措施是发病率，死亡率和治疗outcome.Results：三名患者是女性，年龄从40至77岁不等。入院时，所有患者均出现血栓栓塞相关症状（四肢疼痛或腹痛）。2例患者有静脉血栓栓塞病史（肺栓塞或深静脉血栓形成）。四名患者有高凝状态的生化证据，第五名患有恶性疾病。凝血障碍包括同型半胱氨酸（n = 2）和因子VIII（n = 1）升高、抗凝血酶III（n = 1）和蛋白C缺乏症（n = 1）以及家族性异常纤维蛋白原血症（n = 1）。AMT位于肾下主动脉（n = 1）、拱上主动脉（n = 3）和胸降主动脉（n = 1）。1例患者需要剖腹探查术，1例患者需要下肢血管手术，分别用于内脏和肢体威胁性缺血。全身抗凝治疗导致完全解决后续计算机断层扫描或血管造影的AMT在中位数为60 day.Conclusion：大多数患者中，AMT的发展在没有潜在的主动脉疾病有潜在的凝血功能障碍。单独的抗凝治疗可以解决AMT，手术干预用于治疗血栓栓塞导致的终末器官缺血。
Background. Aortic mural thrombi (AMT) in the absence of aortic disease are rare. The appropriate indications and the efficacy of surgical thrombectomy, thrombolysis, and systemic anticoagulation remain controversial.Methods. This study, set in an academic medical center, was a retrospective review of five patients with AMT in the absence of aortic disease who underwent treatment between 1997 and 2001. The main outcome measures were morbidity, mortality, and treatment outcome.Results: Three patients were women, and ages ranged from 40 to 77 years. On admission, all patients had symptoms related to thrombus embolization (extremity pain or abdominal pain). Two patients had a history of venous thromboembolism (pulmonary embolism or deep venous thrombosis). Four patients had biochemical evidence of hypercoaguability, and the fifth had malignant disease. Coagulation disorders included increased homocysteine (n = 2) and factor VIII (n = 1), antithrombin III (n = 1) and protein C deficiency (n = 1), and familial dysfibrinogenemia (n = 1). AMT were located in the infrarenal (n = 1), suprarcnal (n = 3), and descending thoracic (n = 1) aorta. One patient needed exploratory laparotomy and one needed lower extremity vascular procedures for visceral and limb-threatening ischemia, respectively. Treatment with systemic anticoagulation therapy resulted in complete resolution on follow-up computed tomographic scan or angiogram of the AMT at a median of 60 days.Conclusion: Most patients in whom AMT develops in the absence of underlying aortic disease have underlying coagulation disorders. Anticoagulation therapy alone allows resolution of AMT, with surgical intervention reserved for management of end organ ischemia from thrombus embolization.