Serrano Ricardo A, Kolarczyk Lavinia, Rosenkrans Daniel J
Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Anesthesiology and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Cureus. 2023 Sep 7;15(9):e44836. doi: 10.7759/cureus.44836. eCollection 2023 Sep.
This article reports a case study of a middle-aged patient diagnosed with Ketosis-Prone Diabetes (KPD) and diabetic ketoacidosis who had a mobile thrombus in the distal aortic arch with catastrophic complications from thrombus embolization. The pathogenesis of the mobile aortic thrombus is currently under investigation, with many risk factors having been found. Based on the patient's limited manifestation of atherosclerosis and the absence of any indications of thrombophilia, KPD and inflammation from uncontrolled hyperglycemia likely played a significant role in the formation of the thrombus. KPD is a subtype of diabetes characterized by the abrupt onset of severe hyperglycemia and ketoacidosis. The inflammation caused by uncontrolled hyperglycemia in KPD patients can lead to endothelial dysfunction and the activation of prothrombotic pathways. There is a lack of consensus regarding the optimal approach for managing a mobile aortic thrombus. The main strategies under consideration are conservative care, including anticoagulation alone, invasive removal of the thrombus, or endovascular intervention.
本文报道了一例中年患者的病例研究，该患者被诊断为酮症倾向糖尿病（KPD）和糖尿病酮症酸中毒，其主动脉弓远端有一个移动血栓，并因血栓栓塞引发了灾难性并发症。目前正在研究移动性主动脉血栓的发病机制，已发现许多危险因素。鉴于该患者动脉粥样硬化表现有限且无任何血栓形成倾向迹象，KPD以及未控制的高血糖引发的炎症可能在血栓形成中起了重要作用。KPD是糖尿病的一种亚型，其特征为严重高血糖和酮症酸中毒突然发作。KPD患者未控制的高血糖所引发的炎症可导致内皮功能障碍和促血栓形成途径的激活。对于处理移动性主动脉血栓的最佳方法，目前尚无共识。正在考虑的主要策略包括保守治疗，即仅进行抗凝、侵入性清除血栓或血管内介入治疗。
