Gagliardi J M, Batt M, Khodja R H, Le bas P
Service de Chirurgie Vasculaire, Hôpital Annexe République, Nice, France.
Ann Vasc Surg. 1988 Jul;2(3):201-4. doi: 10.1016/S0890-5096(07)60001-6.
Twenty-six peripheral arterial emboli complicating 14 cases of mural thrombi of the aorta were diagnosed between January 1978 and December 1986. None of these patients had any cardiovascular history; their mean age was 49 years. Presenting signs were acute ischemia of the lower limbs in 12 cases and chronic ischemia in two. Arteriograms and CT scan were diagnostic. The mural thrombi were infrarenal in 13 cases and suprarenal in one. Treatment of the thrombus was surgical in all but one patient. In four cases, treatment of the underlying cause was simultaneous with embolectomy; in nine patients, treatment was secondary because further workup was needed. In one case, the patient died following embolectomy before definitive treatment could be undertaken. Results were considered good in 11 cases (unlimited walking distance, no recurrent emboli), and poor in three cases (two major amputations and one death). The incidence of mural thrombi is not known. In our experience, they accounted for 3.8% of nonaneurysmal aortoiliac lesions operated upon during a nine-year period and were responsible for 5% of peripheral arterial emboli. Mural thrombosis of the aorta constitutes a dangerous condition with a potentially lethal final outcome. Recurrent emboli are inevitable without surgical treatment of the source.
1978年1月至1986年12月期间，共诊断出26例外周动脉栓塞，合并14例主动脉壁血栓形成。这些患者均无心血管病史，平均年龄为49岁。临床表现为12例下肢急性缺血，2例慢性缺血。动脉造影和CT扫描可明确诊断。13例壁血栓位于肾下，1例位于肾上。除1例患者外，其余所有患者的血栓均采用手术治疗。4例患者在取栓术的同时对潜在病因进行了治疗；9例患者因需要进一步检查而进行了二期治疗。1例患者在取栓术后未进行确定性治疗前死亡。11例患者治疗效果良好（行走距离不受限，无复发性栓塞），3例患者治疗效果不佳（2例进行了大截肢，1例死亡）。壁血栓的发病率尚不清楚。根据我们的经验，在9年期间，壁血栓占非动脉瘤性主髂病变手术病例的3.8%，占外周动脉栓塞病例的5%。主动脉壁血栓形成是一种危险的疾病，最终可能导致致命后果。如果不对外周动脉栓塞源进行手术治疗，复发性栓塞将不可避免。
