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

Abstract

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

CLC Number:

R543.1

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.

References

[1] Gaylis H. Primary aortic thrombosis[J]. Circulation, 1958, 17(5): 941-944.
[2] Martins APD, Bertolucci LH, Warpechowski RB, et al. Mobile thrombus of the abdominal aorta: a narrative review[J]. J Vasc Bras, 2022, 21: e20220028. doi:10.1590/1677-5449.202200282.
[3] 何长顺, 张韬, 李清乐, 等. 原发性主动脉壁血栓的诊疗进展[J]. 中国普通外科杂志, 2019, 28(8): 1007-1011. HE Changshun, ZHANG Tao, LI Qingle, et al. Progress in diagnosis and treatment of primary aortic mural thrombus[J]. Chinese Journal of General Surgery, 2019, 28(8): 1007-1011.
[4] Tsilimparis N, Hanack U, Pisimisis G, et al. Thrombus in the non-aneurysmal, non-atherosclerotic descending thoracic aorta: an unusual source of arterial embolism[J]. Eur J Vasc Endovasc Surg, 2011, 41(4): 450-457.
[5] Machleder HI, Takiff H, Lois JF, et al. Aortic mural thrombus: an occult source of arterial thromboembolism[J]. J Vasc Surg, 1986, 4(5): 473-478.
[6] Jiang H, Huang C, Shi Y, et al. Effect of smoking on thrombotic antiphospholipid syndrome: a 10-year prospective cohort study[J]. Rheumatology, 2024, 63(7): 1917-1922.
[7] 邵江, 孔德强, 李康, 等. 多学科综合治疗协作组诊治原发性主动脉附壁血栓致腹主动脉骑跨栓[J]. 中华普通外科杂志, 2023, 38(7): 540-543. SHAO Jiang, KONG Deqiang, LI Kang, et al. Diagnosis and treatment of abdominal aortic straddling thrombosis caused by primary aortic attached thrombosis in multidisciplinary comprehensive treatment cooperative group[J]. Chinese Journal of General Surgery, 2023, 38(7): 540-543.
[8] 张强, 游国超, 徐化静, 等. 主动脉原发性血栓的诊断及治疗[J]. 中华血管外科杂志, 2022, 7(4): 261-268. ZHANG Qiang, YOU Guochao, XU Huajing, et al. Diagnosis and therapy for primary aorticmural thrombus[J]. Chinese Journal of Vascular Surgery, 2022, 7(4): 261-268.
[9] McGuinness B, Goel A, Chen J, et al. The association of cannabis use disorder with acute limb ischemia and critical limb ischemia[J]. Vascular and Endovascular Surgery, 2022, 56(5): 480-494.
[10] Matsumoto Y, Horimasu Y, Yamaguchi K, et al. D-dimer can be a diagnostic marker for cisplatin-related aortic thrombosis: a case report[J]. Medicine, 2021, 100(7): e24695. doi:10.1097/MD.0000000000024695.
[11] Mendes D, Veiga C, Machado R, et al. The challenge of managing a primary aortic mural thrombus: outcomes and technical considerations[J]. The International Journal of Angiology: Official Publication of the International College of Angiology, Inc, 2024, 33(3): 156-164.
[12] Khalil A, Kanitra JJ, Lorelli D. Non-diseased aortic mural thrombus presenting with acute limb ischaemia[J]. BMJ case reports, 2022, 15(3): e247297. doi: 10.1136/bcr-2021-247297.
[13] Fayad ZY, Semaan E, Fahoum B, et al. Aortic mural thrombus in the normal or minimally atherosclerotic aorta[J]. Ann Vasc Surg, 2013, 27(3): 282-290.
[14] Choukroun EM, Labrousse LM, Madonna FP, et al. Mobile thrombus of the thoracic aorta: diagnosis and treatment in 9 cases[J]. Ann Vasc Surg, 2002, 16(6): 714-722.
[15] Nguyen Q, Ma X, Vervoort D, et al. Management strategies for descending thoracic aortic thrombus: a review of the literature[J]. Innovations(Philadelphia, Pa.), 2022, 17(4): 283-296.
[16] Tenenbaum A, Motro M, Shapira I, et al. Fluid dynamics and atherosclerosis development in the human thoracic aorta: a transesophageal echocardiographic evaluation of protruding aortic plaque distribution and motion[J]. J Med, 2000, 31(1/2): 63-76.
[17] 张强, 李晓光, 游国超, 等. 腔内治疗原发性主动脉血栓10例[J]. 介入放射学杂志, 2023, 32(4): 330-337. ZHANG Qiang, LI Xiaoguang, YOU Guochao, et al. Endovascular therapy for primary aortic mural thrombus in ten patients [J]. Journal of Interventional Radiology, 2023, 32(4): 330-337.
[18] Akcelik A, Minakata K, Sunagawa G, et al. Surgical management of primary aortic thrombus in thoracic aorta[J]. JTCVS open, 2023, 16: 84-92. doi:10.1016/j.xjon.2023.09.022.
[19] Sousa P P, Pinto P S. Endovascular treatment of a symptomatic thoracic aorta thrombi[J]. Rev Port Cir Cardiotorac Vasc, 2020, 27(3): 227-230.
[20] Vaidya YP, Schaffert TF, Shaw PM, et al. Management of mobile thrombus of the thoracic aorta[J]. J Vasc Surg Cases Innov Tech, 2021, 7(4): 627-629.
[21] Grassl K, Hangler H, Gratl A, et al. A free-floating aortic Thrombus: an uncommon approach to handle a rare clinical entity[J]. J Endovasc Ther, 2024. doi:10.1177/15266028241256817.
[22] 石静, 谢军, 陈颍, 等. Fogarty球囊导管取栓联合双侧髂动脉球囊阻断术治疗急性肾动脉血栓1例[J]. 介入放射学杂志, 2021, 30(10): 1077-1078. SHI Jing, XIE Jun, CHEN Ying, et al. Fogarty balloon catheter thrombectomy combined with bilateral iliac artery balloon occlusion for acute renal artery thrombosis: report of one case[J]. Journal of Interventional Radiology, 2021, 30(10): 1077-1078.
[23] Esposito D, Gonfiantini F, Fargion AT, et al. Hybrid operating room applications in the increasingly complex endovascular era: the trump card of modern vascular surgery[J]. Ann Surg Treat Res, 2021, 100(1): 54-58.
[24] McClure RS, Berry RF, Dagenais F, et al. The many care models to treat thoracic aortic disease in Canada: a nationwide survey of cardiac surgeons, cardiologists, interventional radiologists, and vascular surgeons[J]. CJC Open, 2021, 3(6): 787-800.
[25] 张雨嫣, 付琴, 刁文杰, 等. 胸主动脉杂交手术的配合体会[J]. 中华全科医学, 2022, 20(11): 1978-1981. ZHANG Yuyan,FU Qin,DIAO Wenjie, et al. Experience in coordination in thoracic aortic hybrid surgery[J]. Chinese Journal of General Practice, 2022, 20(11): 1978-1981.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Comments

Recommended 0

No Suggested Reading articles found!

Single-center experience in diagnosis and treatment of primary aortic thrombosis

PDF (PC)

Abstract

Cite this article

share this article

References

Related Articles 9

Metrics

Comments

Recommended 0

[1]	ZHAO Wenpeng, LYU Fanzhen, HU Yiliang, CHEN Shai, FANG Huaqiang, WANG Shizhi, ZHOU Weimin. Single-center experience in treatment of Stanford type B aortic intramural hematoma [J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 108-114.
[2]	ZHANG Zhiwei, MENG Qingyou, DING Qingwei, ZHANG Xiaoyu. Early results of surgically assisted short-distance retrograde needle puncture technique for in situ fenestration of the aortic arch [J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 93-100.
[3]	LIANG Bowen, LU Qingsheng. Advances in robotic-assisted endovascular aortic repair [J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 61-65.
[4]	YANG Jianping, GUAN Sheng, FANG Qingbo, CI Hongbo, GE Xiaohu. Advances in diagnosis and treatment of blunt thoracic aortic injury [J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 36-41.
[5]	WANG Lunchang, QIN Qi, SHU Chang. Advances in diagnosis and treatment of traumatic type B aortic dissection [J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 19-25.
[6]	WEI Ren, GUO Wei. Current status of endovascular therapy for abdominal aortic aneurysm [J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 13-18.
[7]	HUANG Bosong, CONG Hongliang. Anticoagulant therapy of non-valvular atrial fibrillation in 1,430 middle-aged patients with moderate-risk thromboembolism [J]. Journal of Shandong University (Health Sciences), 2021, 59(10): 49-67.
[8]	YAN Jinxiang, MENG Lei, DONG Yanan, ZHANG Aijun, YUE Hongsheng, LI Bo, ZHONG Liangjun, BAI Aiguo. Application of Solitaire FR stent in the optimized treatment of acute cerebral artery occlusion [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(7): 49-54.
[9]	ZHANG Hong1, JIANG Hai-Jun1, YANG Zhi1, ZHANG Xiao-ming2. Diagnosis and treatment of 67 cases with acute leg ischemia [J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2012, 50(3): 87-89.