Shindo S, Iyori K, Ishimoto T, Kobayashi M, Suzuki O, Yoshii S, Kamiya K, Tada Y
Second Department of Surgery, Yamanashi Medical University, Japan.
Int Angiol. 1997 Sep;16(3):171-5.
Isolated thrombus of the thoracic aorta without aneurysmal change or dissection is a relatively rare event. A case presenting with aortic thrombus and successive distal embolism is reported herein and the aetiology of the thrombus of the distal aortic arch is analysed by a three dimensional aortic model. A 61-year-old man suffered acute ischaemia in his right leg on January 26, 1994. Enhanced computed tomography (CT) showed a localized thrombus in the distal aortic arch expanding towards the descending aorta, and partial infarction of the left kidney and the spleen. Angiography demonstrated abrupt occlusion of the right superficial femoral artery. Immediate anticoagulation with heparin and coumadin was administered, and the thrombus in the aorta disappeared following 1 month of this medical treatment, leaving the renal and splenic infarction unchanged. The unresolved occlusion of the superficial femoral artery and the popliteal artery was treated with a bypass from the right superficial femoral artery to the peroneal artery using a reversed saphenous vein graft. The mould model of the thoracic aorta was reconstructed from CT, and the thrombus was found to be at the most distal and medial site of the lesser curvature of the aortic arch. This specific location is referred mostly as the site for thrombus formation in the literature. The case is reported briefly and the risk of this specific region of the thoracic aorta for thrombus formation is discussed using this mold model.
孤立性胸主动脉血栓形成且无动脉瘤样改变或夹层分离是一种相对罕见的情况。本文报告了一例出现主动脉血栓及相继发生的远端栓塞的病例，并通过三维主动脉模型分析了主动脉弓远端血栓形成的病因。一名61岁男性于1994年1月26日出现右下肢急性缺血。增强计算机断层扫描（CT）显示主动脉弓远端有一局限性血栓，向降主动脉扩展，左肾和脾脏有部分梗死。血管造影显示右股浅动脉突然闭塞。立即给予肝素和香豆素抗凝治疗，治疗1个月后主动脉内血栓消失，但肾和脾梗死情况未改变。未解决的股浅动脉和腘动脉闭塞采用大隐静脉移植从右股浅动脉至腓动脉旁路手术治疗。根据CT重建了胸主动脉的铸型模型，发现血栓位于主动脉弓小弯最远端和内侧部位。该特定位置在文献中大多被认为是血栓形成部位。简要报告该病例，并使用此铸型模型讨论胸主动脉这一特定区域血栓形成的风险。
