Reyes Valdivia Andrés, Duque Santos Africa, Garnica Ureña Marta, Romero Lozano Asunción, Aracil Sanus Enrique, Ocaña Guaita Julia, Gandaria Claudio
Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
Ann Vasc Surg. 2017 Aug;43:121-126. doi: 10.1016/j.avsg.2017.01.005. Epub 2017 Mar 1.
Primary aortic mural thrombus (AMT) is a rare entity. Asymptomatic AMT may be found in imaging studies for other disease studies. Symptomatic AMT as embolic events may localize in the arterial branches of the aorta; limb ischemia is the most usual clinical presentation, though. However, when proximal aorta is compromised, visceral branches occlusion and ischemia may determine morbidity and mortality in these patients.
We performed a retrospective study with collection of data from January 2011 to September 2016. Medical records of patients were reviewed for: demographic data, cardiovascular risk factors or any known prothrombotic predisposing condition, clinical presentation, vessel of embolism, localization of aortic thrombus, treatment of AMT and symptoms, follow-up, and computed tomography scan imaging findings.
A total of 8 patients were included in the study. Mean age was 54.7 ± 11.5 years, with male/female ratio 3:1. Four (50%) patients had AMT at the arch or descending aorta, 3 (37.5%) patients in the infrarenal sector, and the remaining in the visceral aorta. All but one patient received anticoagulation alone for the aortic thrombus. Patient with femoral thromboembolectomy died in the early postoperative time due to severe massive embolism. Median follow-up was 23 months (range, 1-50). Five out of seven patients showed complete aortic thrombus resolution in imaging follow up. None of the patients presented recurrence of embolic events.
An anticoagulation first-approach treatment may be reasonable if mild organ damage is encountered. This strategy may be continued if no recurrences in embolic events are encountered, as high percentage of thrombus resolution is expected. Open or endovascular may be saved for life-threatening visceral or arch branches damage.
原发性主动脉壁血栓（AMT）是一种罕见疾病。无症状性AMT可能在其他疾病的影像学检查中被发现。有症状的AMT作为栓塞事件可能定位于主动脉的动脉分支；然而，肢体缺血是最常见的临床表现。但是，当主动脉近端受累时，内脏分支闭塞和缺血可能决定这些患者的发病率和死亡率。
我们进行了一项回顾性研究，收集了2011年1月至2016年9月的数据。对患者的病历进行了如下回顾：人口统计学数据、心血管危险因素或任何已知的促血栓形成易患因素、临床表现、栓塞血管、主动脉血栓的定位、AMT的治疗及症状、随访以及计算机断层扫描成像结果。
该研究共纳入8例患者。平均年龄为54.7±11.5岁，男女比例为3:1。4例（50%）患者的AMT位于主动脉弓或降主动脉，3例（37.5%）患者位于肾下段，其余位于内脏主动脉。除1例患者外，所有患者均单独接受了抗凝治疗以治疗主动脉血栓。接受股动脉血栓切除术的患者术后早期因严重大面积栓塞死亡。中位随访时间为23个月（范围1 - 50个月）。7例患者中有5例在影像学随访中显示主动脉血栓完全溶解。所有患者均未出现栓塞事件复发。
如果遇到轻度器官损伤，首先采用抗凝治疗可能是合理的。如果未出现栓塞事件复发，可继续采用该策略，因为预计血栓溶解率较高。对于危及生命的内脏或主动脉弓分支损伤，可采用开放手术或血管腔内治疗。
