1
|
Serrano RA, Kolarczyk L, Rosenkrans DJ. A Devastating Floating Aortic Thrombus and Ketosis-Prone Diabetes. Cureus 2023; 15:e44836. [PMID: 37809193 PMCID: PMC10559760 DOI: 10.7759/cureus.44836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
This article reports a case study of a middle-aged patient diagnosed with Ketosis-Prone Diabetes (KPD) and diabetic ketoacidosis who had a mobile thrombus in the distal aortic arch with catastrophic complications from thrombus embolization. The pathogenesis of the mobile aortic thrombus is currently under investigation, with many risk factors having been found. Based on the patient's limited manifestation of atherosclerosis and the absence of any indications of thrombophilia, KPD and inflammation from uncontrolled hyperglycemia likely played a significant role in the formation of the thrombus. KPD is a subtype of diabetes characterized by the abrupt onset of severe hyperglycemia and ketoacidosis. The inflammation caused by uncontrolled hyperglycemia in KPD patients can lead to endothelial dysfunction and the activation of prothrombotic pathways. There is a lack of consensus regarding the optimal approach for managing a mobile aortic thrombus. The main strategies under consideration are conservative care, including anticoagulation alone, invasive removal of the thrombus, or endovascular intervention.
Collapse
Affiliation(s)
- Ricardo A Serrano
- Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Lavinia Kolarczyk
- Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Daniel J Rosenkrans
- Anesthesiology and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, USA
| |
Collapse
|
2
|
Dai Z, Fukuda T, Shiratori Y, Komiyama N. Aortic mural thrombus visualised on transoesophageal echocardiography. BMJ Case Rep 2019; 12:12/3/e229212. [PMID: 30872348 DOI: 10.1136/bcr-2019-229212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Zhehao Dai
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Terunobu Fukuda
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yasutoshi Shiratori
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan
| | - Nobuyuki Komiyama
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| |
Collapse
|
3
|
Knight JB, Chaer RA, Gelzinis TA. Transesophageal Echocardiography for Guidance of Endovascular Stent Exclusion of Thoracic Aortic Thrombi: A Case Series. J Cardiothorac Vasc Anesth 2017; 32:1333-1336. [PMID: 29196137 DOI: 10.1053/j.jvca.2017.08.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Joshua B Knight
- Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA.
| | - Rabih A Chaer
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | | |
Collapse
|
4
|
|
5
|
Krishnamoorthy V, Bhatt K, Nicolau R, Borhani M, Schwartz DE. Transesophageal Echocardiography–Guided Aortic Thrombectomy in a Patient With a Mobile Thoracic Aortic Thrombus. Semin Cardiothorac Vasc Anesth 2011; 15:176-8. [DOI: 10.1177/1089253211415123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thoracic aortic thrombi are a well-known cause of distal embolic phenomena. There is a paucity of case reports because of the rarity of this condition, and thus clear management guidelines are lacking. The authors present a case of a mobile thoracic aortic thrombus managed by a surgical approach. This report demonstrates how intraoperative transesophageal echocardiography (TEE) proved to be critical in guiding surgical management. The utility of TEE in the diagnosis and management of aortic thrombi is also discussed. In addition, currently reported management strategies for this complex condition are reviewed.
Collapse
Affiliation(s)
| | - Kunal Bhatt
- University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | |
Collapse
|
6
|
Pagni S, Trivedi J, Ganzel BL, Williams M, Kapoor N, Ross C, Slater AD. Thoracic Aortic Mobile Thrombus: Is There a Role for Early Surgical Intervention? Ann Thorac Surg 2011; 91:1875-81. [DOI: 10.1016/j.athoracsur.2011.02.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 01/28/2011] [Accepted: 02/04/2011] [Indexed: 11/26/2022]
|
7
|
Acute Left Arm Ischemia Associated with Floating Thrombus in the Proximal Descending Aorta: Combined Endovascular and Surgical Therapy. Cardiovasc Intervent Radiol 2010; 34:193-7. [DOI: 10.1007/s00270-010-9804-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 01/04/2010] [Indexed: 11/25/2022]
|
8
|
Lainez B, Ruiz V, Ramallal R, Cordo JC. Embolias de repetición por trombo en aorta torácica detectado por ecocardiografía transesofágica. ¿Cuál es actualmente el tratamiento más adecuado? Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73089-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
9
|
Lainez B, Ruiz V, Ramallal R, Cordo JC. Recurrent embolism due to thoracic aortic thrombus detected by transesophageal echocardiography. Which treatment is currently the most appropriate? Rev Esp Cardiol 2009; 62:1335-1337. [PMID: 19889348 DOI: 10.1016/s1885-5857(09)73364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
10
|
Luckeroth P, Steppacher R, Rohrer MJ, Eslami MH. Endovascular Therapy for Symptomatic Mobile Thrombus of Infrarenal Abdominal Aorta. Vasc Endovascular Surg 2009; 43:518-23. [DOI: 10.1177/1538574409334823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mobile thrombus is a rare cause of distal arterial embolization. We report 2 cases of mobile thrombus of the abdominal aorta leading to distal embolization. Both patients were successfully treated with endovascular exclusion of the thrombus and distal embolectomy. Endovascular exclusion of a mobile thrombus of the abdominal aorta is a significantly less invasive alternative to open abdominal aorta thrombectomy.
Collapse
Affiliation(s)
- Patricia Luckeroth
- Departments of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert Steppacher
- Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Michael J. Rohrer
- Division of Vascular Surgery, University of Tennessee Medical School, Memphis, Tennessee
| | - Mohammad H. Eslami
- Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Massachusetts,
| |
Collapse
|
11
|
Piffaretti G, Tozzi M, Mariscalco G, Bacuzzi A, Lomazzi C, Rivolta N, Carrafiello G, Castelli P. Mobile Thrombus of the Thoracic Aorta: Management and Treatment Review. Vasc Endovascular Surg 2008; 42:405-11. [DOI: 10.1177/1538574408324737] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Detection of mobile thrombus of the thoracic aorta has become increasingly higher after any embolic event. Although the indication for treatment remains controversial, there is a growing interest about the ethiopathogenesis of this rare entity, and to define proper diagnostic and therapeutic approaches. The purpose of this article was to review the current management strategies and follow-up results of this rare pathology.
Collapse
Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy, gabriele.piffaretti@ tiscali.it
| | - Matteo Tozzi
- Vascular Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy
| | - Giovanni Mariscalco
- Cardiac Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy
| | - Alessandro Bacuzzi
- Anaesthesia and Palliative Care, Circolo University Hospital, Varese, Italy
| | - Chiara Lomazzi
- Vascular Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy
| | - Nicola Rivolta
- Vascular Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy
| | - Gianpaolo Carrafiello
- Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
| | - Patrizio Castelli
- Vascular Surgery, Department of Surgical Sciences, University of Insubria, Varese, Italy
| |
Collapse
|
12
|
Hípola-Ulecia J, Herrero-Bernabé M, Gallardo-Hoyos Y, Agúndez-Gómez I, Mateos-Otero F, Fonseca-Legrand J. Trombo en la aorta torácica como causa de embolismo periférico. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)03006-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
13
|
|
14
|
Harloff A, Handke M, Geibel A, Oehm E, Guschlbauer B, Olschewski M, Hetzel A. Do stroke patients with normal carotid arteries require TEE for exclusion of relevant aortic plaques? J Neurol Neurosurg Psychiatry 2005; 76:1654-8. [PMID: 16291889 PMCID: PMC1739459 DOI: 10.1136/jnnp.2005.065821] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study investigated (a) the hypothesis that stroke patients with aortic atheroma would show comparable atherosclerotic changes in the carotid arteries, which are easily accessible for ultrasound evaluation and (b) the possibility of carotid duplex sonography as a replacement for transoesophageal echocardiography (TEE) for the exclusion or prediction of relevant aortic plaques. METHODS In 301 consecutive patients (mean age 62 years) with acute cerebral ischaemia, two dimensional ultrasound measurements were taken of common carotid artery intima media thickness (IMT) and maximal plaque area (PA) and the local degree of internal carotid artery (ICA) stenosis were determined. Maximal aortic wall thickness (AWT) was assessed by TEE. RESULTS An IMT < or =0.9 mm yielded a negative predictive value (NPV) of 95.8% for exclusion of aortic atheromas > or =4 mm and an NPV of 100% for the exclusion of aortic thrombi. However, positive predictive value of IMT >0.9 mm was low (29.6%), increasing only slightly in the presence of carotid plaques (33%). Incidence of aortic thrombi was significantly higher with > or =50% compared with <50% ICA stenosis (11.3% v 3.9%, respectively). IMT and PA correlated moderately with AWT (r = 0.47, r = 0.53, respectively; p<0.001). Systolic blood pressure, coronary heart disease and peripheral artery disease, increased IMT, and ICA stenosis > or =50% were independently related to AWT > or =4 mm. CONCLUSIONS A high NPV of normal carotid ultrasound does not support routine TEE for the exclusion of complex aortic plaques as a high risk source of cerebral embolism. However, in patients with carotid atherosclerosis, particularly in those with ICA stenosis > or =50%, TEE should be performed to exclude an additional high risk source for stroke.
Collapse
Affiliation(s)
- A Harloff
- Department of Neurology and Clinical Neurophysiology, Albert-Ludwigs-Universität, Breisacher Strasse 64, D-79106 Freiburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
15
|
Fueglistaler P, Wolff T, Guerke L, Stierli P, Eugster T. Endovascular stent graft for symptomatic mobile thrombus of the thoracic aorta. J Vasc Surg 2005; 42:781-3. [PMID: 16242568 DOI: 10.1016/j.jvs.2005.05.054] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 05/29/2005] [Indexed: 10/25/2022]
Abstract
Mobile thoracic aortic thrombus is a potential source of arterial embolism. Therapeutic management remains controversial. Systemic anticoagulation and various open surgical procedures are the commonly used therapeutic modalities. We report the successful primary treatment by endovascular stent graft of a mobile thoracic aortic thrombus that had caused visceral and peripheral embolism. Our case shows that endovascular stent-graft treatment is an effective, minimally invasive treatment of symptomatic mobile thoracic aortic thrombus.
Collapse
Affiliation(s)
- Philipp Fueglistaler
- University Centre for Vascular Surgery, University Hospital Aauru/Basle, Basel, Switzerland
| | | | | | | | | |
Collapse
|