Hahn T L, Dalsing M C, Sawchuk A P, Cikrit D F, Lalka S G
Department of Surgery, Peripheral Vascular Surgery Section, Indiana University School of Medicine, Indianapolis, IN.
Ann Vasc Surg. 1999 Jan;13(1):52-9. doi: 10.1007/s100169900220.
The clinical presentation of patients with acute lower-limb ischemia and primary aortic thrombus prompted this review. Following recognition of the first case in early 1994, relevant patients (n = 6) were kept in a database and were reviewed for presentation, treatment, and follow-up. The median age was 41 and five patients were male. Angiography, computed tomography, and/or magnetic resonance angiography demonstrated one or more aortic sessile or pedunculated thrombus(i) without associated atherosclerotic disease. In two cases, a retropancreatic intraaortic mural thrombus was associated with severe pancreatitis. All other cases presented with acute lower-limb emboli requiring limb salvage embolectomy. Because of significant patient illness, systemic anticoagulation was chosen acutely to prevent recurrent emboli. Interestingly, serial studies demonstrated aortic thrombus resolution. Failure to continue warfarin therapy resulted in recurrent problems (n = 1) unless the instigating event had resolved (n = 3). There were no deaths or amputations. We concluded that surgical embolectomy, when required, with subsequent anticoagulation, results in limb salvage and allows for eventual resolution of the primary aortic thrombus. Long-term anticoagulation is required unless the etiologic process resolves. The literature describes patients with atherosclerosis and overlying thrombus but fails to describe the approach to patients with primary thrombus formation.
急性下肢缺血合并原发性主动脉血栓患者的临床表现促使了本综述的开展。自1994年初确诊首例病例后，相关患者（n = 6）被纳入数据库，并对其临床表现、治疗及随访情况进行回顾。患者中位年龄为41岁，男性5例。血管造影、计算机断层扫描及/或磁共振血管造影显示存在一个或多个无相关动脉粥样硬化疾病的主动脉无蒂或有蒂血栓。2例患者中，胰后主动脉壁内血栓与重症胰腺炎相关。所有其他病例均表现为急性下肢栓子，需要进行肢体挽救性取栓术。由于患者病情严重，急性期选择全身抗凝以预防栓子复发。有趣的是，系列研究显示主动脉血栓溶解。除非诱发事件已缓解（n = 3），否则停用华法林治疗会导致复发问题（n = 1）。无死亡或截肢病例。我们得出结论，必要时进行手术取栓并随后抗凝，可挽救肢体并使原发性主动脉血栓最终溶解。除非病因消除，否则需要长期抗凝。文献描述了动脉粥样硬化合并血栓形成的患者，但未描述原发性血栓形成患者的治疗方法。
