Thrombus in the Non-aneurysmal, Non-atherosclerotic Descending Thoracic Aorta - An Unusual Source of Arterial Embolism
Thrombus in the Non-aneurysmal, Non-atherosclerotic Descending Thoracic Aorta - An Unusual Source of Arterial Embolism
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DOI：
10.1016/j.ejvs.2010.11.004
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发表时间：
2011-04-01
影响因子：
5.7
通讯作者：
Rueckert, R. I.
中科院分区：
文献类型：
--
作者：
Tsilimparis, N.;Hanack, U.;Rueckert, R. I.
简介：胸主动脉附壁血栓是一种罕见的临床表现，在没有动脉瘤或动脉粥样硬化。方法：所有患者的病历诊断为一个非动脉瘤和非动脉粥样硬化性胸降主动脉（NAADTA）血栓和治疗的资深作者04/1997年至04/2010年。结果：8例患者的NAADTA附壁血栓确定。动脉栓塞是所有病例的主要临床表现，累及下肢（n = 6）、肠系膜（n = 3）或肾动脉（n = 2）。3例患者存在高凝障碍，另外3例患者同时存在恶性肿瘤。2例患者接受开放手术，4例患者接受抗凝治疗。在其余2例患者中，1例患者接受胸主动脉覆膜支架和髂动脉-双髂动脉旁路术治疗，另1例患者接受经股动脉血栓切除术治疗。所有手术病例均获得技术成功，保守治疗组血栓消退或疾病稳定。平均随访49个月，没有观察到血栓复发。结论：NAADTA附壁血栓的管理是一个挑战，特别是在恶性疾病或高凝障碍作为一个潜在的潜在病理，应个体化。虽然在文献中没有达成共识，但建议将治疗性抗凝作为一线治疗。外科干预的适应症是抗凝、移动的血栓或复发性栓塞的禁忌症。如果可能，应首选血管内治疗。(C)2010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。
Introduction: Mural thrombus of the thoracic aorta is a rare clinical finding in the absence of aneurysm or atherosclerosis.Methods: The medical records of all patients diagnosed with a thrombus of a non-aneurysmatic and non-atherosclerotic descending thoracic aorta (NAADTA) and treated by the senior author between 04/1997 and 04/2010 were reviewed.Results: Eight patients with mural thrombus of the NAADTA were identified. Arterial embolism was the main clinical finding in all cases and involved the lower extremities (n = 6), mesenteric (n = 3) or renal arteries (n = 2). Hypercoagulable disorders were present in 3 cases and a concurrent malignancy in another 3. Two patients underwent open surgery while 4 patients were treated conservatively with anticoagulation. Of the remaining 2 patients, one was treated with a thoracic stent-graft and aorto-biiliac bypass and the other one with transfemoral thrombectomy. Technical success was achieved in all surgical cases and thrombus resolution or stable disease in the conservative management group. No thrombus recurrence was observed during a mean follow-up of 49 months.Conclusion: The management of mural thrombus in NAADTA represents a challenge, especially in case of malignant disease or hypercoagulable disorder as a potential underlying pathology and should be individualized. Although no consensus exists in the literature, therapeutic anticoagulation is proposed as first-line therapy. The indication for surgical intervention results from contraindication to anticoagulation, mobile thrombus or recurrent embolism. Whenever possible, endovascular therapy should be preferred. (C) 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.