Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, Italy.
Department of Biomedical Sciences for Health, University of Milan, Italy.
Vasc Endovascular Surg. 2023 Apr;57(3):264-271. doi: 10.1177/15385744221141219. Epub 2022 Nov 18.
To present stent-graft treatment of floating thrombus in the abdominal aorta. A review of the literature about aortic floating thrombus (AFT) was also performed.
A 56-year-old female with no risk factors for vascular disease but with history of a mild COVID-19 infection in the previous month, for which she had started anticoagulant therapy at a prophylactic dosage, developed an acute ischemia of the lower limbs and was diagnosed with floating thrombosis of the abdominal aorta. The thrombus was excluded from the aortic blood flow by deployment of a stent-graft in the abdominal aorta. At 12 months, the patient was well, and the thrombus in the abdominal aorta appears to be completely excluded by the stent-graft. A review of the available literature from 1980 to 2022 showed 74 cases of AFT located in the aortic arch, in the descending thoracic and in the abdominal aorta. In most cases the AFT involved the aortic arch (38/74, 51.3%) and/or the descending thoracic aorta (30/74, 40.5%), while the abdominal aorta was involved in 6 cases. In 2 of these 6 cases, the patients had a COVID-19 infection. The AFT was mostly approached either medically with anticoagulation/systemic thrombolysis (32/74, 43.2%) or with surgical removal (31/74, 41.9%), while endovascular coverage of the thrombus with an endograft was performed in 6 cases of AFT located in the aortic arch and in the descending thoracic aorta (3 cases each).
There is no consensus about the optimal treatment of AFT. In selected cases, abdominal stent-grafts may be used for stabilization and exclusion of symptomatic abdominal aorta floating thrombosis to prevent progression and recurrent embolization.
介绍腹主动脉漂浮血栓的支架治疗。同时对主动脉漂浮血栓（AFT）的文献进行了回顾。
一位 56 岁的女性，无血管疾病的危险因素，但在过去一个月有轻度 COVID-19 感染史，为此她开始进行预防性剂量的抗凝治疗，出现下肢急性缺血，并诊断为腹主动脉漂浮血栓。通过在腹主动脉中放置支架移植物，将血栓从主动脉血流中排除。12 个月后，患者情况良好，腹主动脉中的血栓似乎已完全被支架移植物排除。对 1980 年至 2022 年期间的可用文献进行综述，显示 74 例位于主动脉弓、降胸段和腹主动脉的 AFT。在大多数情况下，AFT 累及主动脉弓（38/74，51.3%）和/或降胸段（30/74，40.5%），而腹主动脉受累 6 例。在这 6 例患者中，有 2 例患有 COVID-19 感染。AFT 主要通过抗凝/全身溶栓（32/74，43.2%）或手术切除（31/74，41.9%）来治疗，而对位于主动脉弓和降胸段的 6 例 AFT 则通过支架移植物进行血栓的腔内覆盖（各 3 例）。
对于 AFT 的最佳治疗方法尚无共识。在选择的病例中，腹部支架移植物可用于稳定和排除有症状的腹主动脉漂浮血栓，以防止进展和复发性栓塞。
