Lau L S, Blanchard D G, Hye R J
Department of Surgery, University of California, San Diego 92103-8401, USA.
Ann Vasc Surg. 1997 Jul;11(4):348-53. doi: 10.1007/s100169900059.
Transesophageal echocardiography (TEE) has improved the detection of thoracic aortic pathology and further elucidated its role as a source of peripheral arterial emboli. Since 1993 we have used TEE to evaluate the thoracic aorta in patients with peripheral emboli without identifiable cardiac sources. Five patients suffered a total of eight embolic events originating from thoracic aortic mural thrombus (TAMT). The four females and one male ranged in age from 56 to 82 years. Emboli occurred to the upper extremities in four instances, lower extremities in three instances, and the visceral vessels in a single instance. Thromboembolectomy was performed in each case except for a patient who initially underwent aortobifemoral bypass. He was discovered to have TAMT after a subsequent embolic event. All patients were anticoagulated after TAMT was identified but in one case anticoagulants were discontinued after an intraabdominal hemorrhage. All patients are alive without limb loss while one patient has experienced recurrent embolization despite anticoagulation. TEE is a sensitive and useful diagnostic modality in patients with "cryptogenic" arterial embolization. Whether surgical management or anticoagulation for the primary lesion is optimal therapy remains a question. However, anticoagulation appears effective in this small experience.
经食管超声心动图（TEE）提高了胸主动脉病变的检出率，并进一步阐明了其作为外周动脉栓子来源的作用。自1993年以来，我们使用TEE对无明确心脏来源的外周栓子患者的胸主动脉进行评估。5例患者共发生8次源于胸主动脉壁血栓（TAMT）的栓塞事件。4名女性和1名男性，年龄在56至82岁之间。上肢栓塞4例，下肢栓塞3例，内脏血管栓塞1例。除1例最初接受主动脉双股动脉旁路移植术的患者外，其余患者均行血栓切除术。该患者在随后的栓塞事件后被发现患有TAMT。所有患者在确诊TAMT后均接受抗凝治疗，但1例患者在发生腹腔内出血后停用了抗凝剂。所有患者均存活，无肢体缺失，1例患者尽管接受了抗凝治疗仍出现复发性栓塞。TEE是诊断“隐源性”动脉栓塞患者的一种敏感且有用的检查方法。对于原发性病变，手术治疗或抗凝治疗哪种是最佳治疗方案仍是一个问题。然而，在这一小样本经验中，抗凝治疗似乎是有效的。
