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Giannetta M, Mazzaccaro D, Righini P, Nano G. Endovascular Treatment of Abdominal Aorta Floating Thrombus in a Patient with Recurrent Peripheral Embolization and COVID-19. Vasc Endovascular Surg 2023; 57:264-271. [PMID: 36398595 PMCID: PMC9679312 DOI: 10.1177/15385744221141219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To present stent-graft treatment of floating thrombus in the abdominal aorta. A review of the literature about aortic floating thrombus (AFT) was also performed. CASE REPORT A 56-year-old female with no risk factors for vascular disease but with history of a mild COVID-19 infection in the previous month, for which she had started anticoagulant therapy at a prophylactic dosage, developed an acute ischemia of the lower limbs and was diagnosed with floating thrombosis of the abdominal aorta. The thrombus was excluded from the aortic blood flow by deployment of a stent-graft in the abdominal aorta. At 12 months, the patient was well, and the thrombus in the abdominal aorta appears to be completely excluded by the stent-graft. A review of the available literature from 1980 to 2022 showed 74 cases of AFT located in the aortic arch, in the descending thoracic and in the abdominal aorta. In most cases the AFT involved the aortic arch (38/74, 51.3%) and/or the descending thoracic aorta (30/74, 40.5%), while the abdominal aorta was involved in 6 cases. In 2 of these 6 cases, the patients had a COVID-19 infection. The AFT was mostly approached either medically with anticoagulation/systemic thrombolysis (32/74, 43.2%) or with surgical removal (31/74, 41.9%), while endovascular coverage of the thrombus with an endograft was performed in 6 cases of AFT located in the aortic arch and in the descending thoracic aorta (3 cases each). CONCLUSION There is no consensus about the optimal treatment of AFT. In selected cases, abdominal stent-grafts may be used for stabilization and exclusion of symptomatic abdominal aorta floating thrombosis to prevent progression and recurrent embolization.
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Affiliation(s)
- Matteo Giannetta
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, Italy
| | - Daniela Mazzaccaro
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, Italy
| | - Paolo Righini
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, Italy
| | - Giovanni Nano
- Operative Unit of Vascular Surgery, 27288IRCCS Policlinico San Donato, Italy.,Department of Biomedical Sciences for Health, University of Milan, Italy
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Ikrou H, Boustani S, Ibenyahia A, Marsafi O, Wakrim S, Elmekkaoui A, Benlenda O, Nassik H. Free floating aorto-iliac thrombosis: A rare complication of COVID-19 pneumonia. Radiol Case Rep 2023; 18:410-415. [PMCID: PMC9673010 DOI: 10.1016/j.radcr.2022.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022] Open
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DeKornfeld GM, Boll J, Ziegler KR, Ratcliff J, Naslund TC, Garrard CL, Valentine RJ, Curci JA. Initial and intermediate-term treatment of the phantom thrombus (primary non-occlusive mural thrombus on normal arteries). Vasc Med 2018; 23:549-554. [PMID: 30124120 DOI: 10.1177/1358863x18788952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An embolic event originating from thrombus on an otherwise un-diseased or minimally diseased proximal artery (Phantom Thrombus) is a rare but significant clinical challenge. All patients from a single center with an imaging defined luminal thrombus with a focal mural attachment site on an artery were evaluated retrospectively. We excluded all patients with underlying anatomic abnormalities of the vessel at the attachment site. Six patients with a mean age of 62.5 years were identified over a 2.5-year period. All patients had completed treatment for or had a current diagnosis of malignancy and none were on antiplatelets or other anticoagulants. Four thrombi originated in the aorta proximal to the renal arteries and one originated distal. One thrombus was found in the common carotid artery and one was in an arterialized vein graft. Mean follow-up was 22 months. None of the patients underwent removal or exclusion of the embolic source. With systemic anticoagulation, four of the phantom thrombi were resolved on imaging within 8 weeks, one resolved after 72 weeks. One phantom thrombus reoccurred after 6 months on reduced anticoagulant dosing. There was one acute and one death in follow-up (26 months). One patient required a partial foot amputation secondary to tissue necrosis from the initial thromboembolic event. Arterial thrombi forming on otherwise normal vessels are a distinct clinical entity. In patients with a phantom thrombus, a strategy of therapeutic anticoagulation for management of the embolic source seems to be safe and effective over both the short and intermediate-term.
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Affiliation(s)
| | | | - Kenneth R Ziegler
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jonathan Ratcliff
- Division of Vascular Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Thomas C Naslund
- Division of Vascular Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - C Louis Garrard
- Division of Vascular Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - R James Valentine
- Division of Vascular Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John A Curci
- Division of Vascular Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Karaolanis G, Moris D, Bakoyiannis C, Tsilimigras DI, Palla VV, Spartalis E, Schizas D, Georgopoulos S. A critical reappraisal of the treatment modalities of normal appearing thoracic aorta mural thrombi. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:306. [PMID: 28856146 DOI: 10.21037/atm.2017.05.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mural thrombus in non-atherosclerotic or aneurysmatic thoracic aorta is a relatively uncommon entity. Currently there is no consensus on the appropriate therapeutic algorithm of its management. We aim to present the current knowledge on the treatment of thoracic aorta mural thrombi (TAMT) in minimally atherosclerotic vessels and we hope that the juxtaposed discussions will shed light on the uncharted waters regarding this rare syndrome. The MEDLINE/PubMed database was searched for publications with the medical subject "aortic mural thrombus" and keywords "thoracic", "embolism", "normal vessel", "minimally atherosclerotic vessel" or "treatment". We restricted our search to English language, till January 2017. The electronic literature search yielded 23 reports that were deemed appropriate for further analysis. Anticoagulation is the standard of care for the treatment of the thrombus whereas surgical and interventional treatment seems to be related with increased mortality and lower recurrence rates. TAMT treatment is controversial. Anticoagulants are the mainstay of treatment but surgery seems to gain ground in several settings as an only therapy or a combined treatment modality. More data are needed on the role of novel oral anticoagulants and endografts.
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Affiliation(s)
- Georgios Karaolanis
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Demetrios Moris
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Chris Bakoyiannis
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Diamantis I Tsilimigras
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Viktoria-Varvara Palla
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Eleftherios Spartalis
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
| | - Sotirios Georgopoulos
- 1st Department of Surgery, Vascular Surgery Unit, Laikon General Hospital, Medical School of Athens, Athens, Greece
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Thrombus in the Non-aneurysmal, Non-atherosclerotic Descending Thoracic Aorta – An Unusual Source of Arterial Embolism. Eur J Vasc Endovasc Surg 2011; 41:450-7. [DOI: 10.1016/j.ejvs.2010.11.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 11/04/2010] [Indexed: 11/18/2022]
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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.
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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,
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Wadoodi A, Sapsford RJ, Patel J, Scott DJA. Images in vascular medicine. Primary aortic thrombosis as seen with transoesophageal echo and MR angiogram. Vasc Med 2005; 9:231-2. [PMID: 15675193 DOI: 10.1191/1358863x04vm547xx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A Wadoodi
- Department of Vascular Surgery, St James Hospital, Beckett Wing, Leeds, UK
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Ockert S, Schumacher H, Böckler D, Schwarzbach M, Rotert H, Allenberg JR. Intravasale Raumforderungen der thorakalen Aorta. Chirurg 2004; 75:1215-20. [PMID: 15309267 DOI: 10.1007/s00104-004-0926-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aortic intraluminal mass lesions of the thoracic aorta are rare disorders with a wide range of differential diagnoses. Generalized hypercoagulation or vascular endothelial disorders have been proposed as the main etiological factor. The risk of catheter-related thrombus development or embolization after interventional procedures is as high as 17%. Malignancies of the aorta are somewhat rare. In some cases, the specific source of the thrombus could not be determined. Mainly, intraluminal tumors of the thoracic aorta become evident through peripheral embolization. Modern diagnostic tools are able to identify the structure and location of intravascular formations. Therapy options are influenced, due to the heterogenic entity, by the individual risk to the patient and the pathology of the thrombus.
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Affiliation(s)
- S Ockert
- Abteilung für Gefässchirurgie, vaskuläre und endovaskuläre Chirurgie, Universitätsklinikum Heidelberg.
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