Grassl Kristina, Hangler Herbert, Gratl Alexandra, Enzmann Florian, Grimm Michael, Klocker Josef, Wipper Sabine
Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
J Endovasc Ther. 2024 May 30:15266028241256817. doi: 10.1177/15266028241256817.
Thrombotic material in the non-aneurysmatic and non-atherosclerotic aorta is a rare entity without any recommended standard treatment so far. We present a successful treatment strategy for patients who do not fit into any of the common approaches.
A free-floating thrombus in the descending aorta was found as source of embolism in an 82-year-old female patient with lower limb ischemia. After initial heparinization of the patient without relevant reduction of the thrombotic mass, the thrombus was removed using an interdisciplinary approach. Under echocardiographic guidance to locate the thrombus, the AngioVac device, usually licensed to remove floating thrombi from the venous system, was used off-label to remove the thrombus by a transfemoral approach. To avoid rebuilding of a new thrombus, the attachment point with an exulcerated plaque in the descending aorta was covered by a stent graft via the same femoral access. The patient did not experience any further embolic events, and the postoperative course was uncomplicated.
Patients with uncommon aortic diseases, such as the reported free-floating thrombus, should be treated by an individualized, interdisciplinary approach. Besides the recommended treatment options, there are other uncommon approaches that might offer an alternative in complex cases.
Evidence is rare for the treatment of a free-floating thrombus in the descending aorta and the treatment strategy remains discussed controversially. We present a rather uncommon approach of successful off-label treatment for patients who do not fit into any of the common approaches (operative, endovascular, or conservative treatment based on patient's comorbidities). The AngioVac System has already been successfully used off-label in the arterial system but not in the above presented way of treating a free-floating thrombus in a patient with high embolization risk and treatment-limiting comorbidities.
非动脉瘤性和非动脉粥样硬化性主动脉内的血栓物质是一种罕见实体，目前尚无推荐的标准治疗方法。我们为不符合任何常见治疗方法的患者提出了一种成功的治疗策略。
一名82岁下肢缺血女性患者，降主动脉内发现游离血栓为栓子来源。患者初始肝素化后血栓体积无明显缩小，遂采用多学科方法清除血栓。在超声心动图引导下定位血栓，通常用于清除静脉系统中游离血栓的AngioVac装置经股动脉途径用于清除血栓，但属于超适应证使用。为避免新血栓形成，通过同一股动脉入路用覆膜支架覆盖降主动脉内有溃疡斑块的血栓附着点。患者未再发生栓塞事件，术后病程顺利。
对于罕见的主动脉疾病患者，如报告的游离血栓患者，应采用个体化的多学科方法进行治疗。除了推荐的治疗方案外，在复杂病例中可能还有其他不常见的方法可供选择。
降主动脉游离血栓的治疗证据罕见，治疗策略仍存在争议。我们为不符合任何常见治疗方法（手术、血管内或基于患者合并症的保守治疗）的患者提出了一种相当不常见的成功超适应证治疗方法。AngioVac系统已成功超适应证用于动脉系统，但并非以上述治疗高栓塞风险且有治疗限制合并症患者游离血栓的方式使用。
