原发性主动脉血栓形成诊治单中心经验

doi:10.6040/j.issn.1671-7554.0.2024.0603

摘要/Abstract

摘要： 目的探究原发性主动脉血栓形成(primary aortic thrombosis, PAT)的诊治方法及预后。方法回顾性收集2017年1月至2023年12月于山东第一医科大学附属省立医院血管外科接受治疗的21例PAT患者的临床数据,包括性别、年龄、合并症、术前临床及辅助检查资料等,总结其临床特点、治疗方案及随访预后等信息。结果纳入21例PAT患者首发症状均为肢体或内脏缺血,其中包括Ⅱ型7例,Ⅲ型2例,Ⅳ型9例,Ⅱ+Ⅲ型1例,Ⅱ+Ⅳ型1例,Ⅲ+Ⅳ型1例。所有患者入院后均进行规范抗凝治疗,其中15例患者接受手术取栓或胸主动脉腔内修复术(thoracic endovascular aortic repair, TEVAR),术后接受长期抗凝、抗血小板治疗;6例患者全程抗凝、抗血小板治疗,未行手术。中位随访时间18个月,随访期间1例患者出现下肢缺血症状,2例患者死亡,其他患者未诉不适,未再发内脏或下肢缺血。结论对于无法确定栓子来源的急性肢体或内脏缺血,应当考虑PAT;发现PAT,若无抗凝禁忌,应全程抗凝治疗,普通肝素持续泵入效果可能优于低分子肝素;TEVAR对于预防再发栓塞有意义,术后应严格定期复查,动态观察PAT的病变,避免再次栓塞事件的发生。

关键词: 原发性主动脉血栓形成, 动脉栓塞, 主动脉腔内修复术, 取栓术, 抗凝治疗

Abstract: Objective To explore the diagnosis, treatment and prognosis of primary aortic thrombosis(PAT). Methods Clinical data from 21 patients with PAT treated in the Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2023 were retrospectively collected, including gender, age, comorbidities, preoperative and auxiliary examination data, to summarize the information on their clinical characteristics, treatment plan, and follow-up prognosis. Results The first symptom of all the 21 patients was limb or visceral ischemia, including 7 cases of type Ⅱ, 2 cases of type Ⅲ, 9 cases of type Ⅳ, 1 case of type Ⅱ+Ⅲ, 1 case of type Ⅱ+Ⅳ and 1 case of type Ⅲ+Ⅳ. All patients underwent standardized anticoagulation therapy after admission. Among them, 15 patients received surgical thrombectomy or thoracic endovascular aortic repair(TEVAR)and long-term anticoagulant and antiplatelet therapy after surgery, and 6 patients underwent complete anticoagulation and antiplatelet therapy without operation. The median follow-up time was 18 months. During the follow-up period, 1 patient developed symptoms of lower limb ischemia, 2 patients died, and the rest of the patients did not complain of discomfort and did not suffer from recurrence of visceral or lower limb ischemia. Conclusions PAT should be considered for acute limb or visceral ischemia when the source of embolus cannot be determined. If PAT is found, anticoagulation therapy should be applied throughout the course unless there are contraindications to anticoagulation. Continuous pumping of ordinary heparin may have a better effect than low-molecular-weight heparin. TEVAR is significant for the prevention of recurrent embolization, and the postoperative periodical review should be strict, and dynamic observation of PAT lesions should be carried out, so as to avoid reembolism events.

Key words: Primary aortic thrombosis, Arterial embolism, Endovascular aortic repair, Thrombectomy, Anticoagulant therapy

中图分类号:

R543.1

王潇晗,吴学君,董典宁,王茂华,韩宗霖,高培显,孔祥骞. 原发性主动脉血栓形成诊治单中心经验[J]. 山东大学学报 (医学版), 2024, 62(9): 115-124.

WANG Xiaohan, WU Xuejun, DONG Dianning, WANG Maohua, HAN Zonglin, GAO Peixian, KONG Xiangqian. Single-center experience in diagnosis and treatment of primary aortic thrombosis[J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 115-124.

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