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Hengst D, Kandah D, Dervesh R, Ellerman M, Ugwu J, Goerbig-Campbell J, Campbell D. Eosinophilic Myocarditis Resulting in Ventricular Tachycardia Storm. Cureus 2024; 16:e56779. [PMID: 38650811 PMCID: PMC11034619 DOI: 10.7759/cureus.56779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
Eosinophilic myocarditis (EM) is a rare but potentially fatal complication of sustained eosinophilia that is characterized by eosinophilic infiltration into myocardial tissue. There are various etiologies of EM that can be classified into general categories: reactive, clonal, and idiopathic. We present a case of EM caused by chronic eosinophilic leukemia, a rare myeloproliferative neoplasm that frequently presents with sustained peripheral eosinophilia. This case displays several serious complications of EM, including recurrent ventricular tachycardia storm, cardiogenic shock, and mural thrombus formation despite anticoagulation. Diagnosis of EM can be difficult as formal diagnosis requires an endomyocardial biopsy. Once EM is suspected, identifying the underlying etiology of eosinophilia is critical for timely implementation of disease-specific therapy.
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Affiliation(s)
- Dylan Hengst
- Internal Medicine, MercyOne Des Moines Medical Center, Des Moines, USA
| | - Daniel Kandah
- Cardiology, MercyOne Des Moines Medical Center, Des Moines, USA
| | | | | | - Justin Ugwu
- Interventional Cardiology, University of Kansas Medical Center, Kansas City, USA
| | | | - Dwayne Campbell
- Cardiology, MercyOne Des Moines Medical Center, Des Moines, USA
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2
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Bosse BL, Wilkinson G, Anderson ZN, Babu J, Rajesh R, Rangaswamy R, Raghuram K. Aplastic Internal Carotid Artery: A Potentially Catastrophic Vascular Anomaly. Diagnostics (Basel) 2023; 13:3089. [PMID: 37835832 PMCID: PMC10573047 DOI: 10.3390/diagnostics13193089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Congenital absence of an internal carotid artery (ICA) is a rare vascular anomaly and occurs in less than 0.01% of the population. We report a case of aplastic internal carotid artery in a 34-year-old female. The patient presented to the emergency department with complaints of new-onset involuntary swaying-like movement of her right arm. Brain magnetic resonance imaging showed multifocal tiny areas of acute infarcts in the bilateral frontal, parietal, and left occipital lobes in the watershed distribution. There was no visualization of the flow of the intracranial left internal carotid artery. Follow-up CTA of the head and neck showed a congenital absence of the left internal carotid artery with no evidence of arterial dissection, occlusion, or aneurysm. Obstruction of the internal carotid artery has significant consequences for patients. This effect is amplified if the disruption occurs in the sole anterior blood supply to the parenchyma of the brain, as in this case. In our patient care, imaging was vital to the detection and subsequent treatment with anticoagulation to avoid further cerebral complications, and the patient will now have a better understanding of the increased lifetime risk of further events.
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Affiliation(s)
- Benjamin L. Bosse
- School of Medicine, University of Nevada, Reno, NV 89557, USA; (B.L.B.); (G.W.)
| | - Geoffrey Wilkinson
- School of Medicine, University of Nevada, Reno, NV 89557, USA; (B.L.B.); (G.W.)
| | - Zoe N. Anderson
- School of Medicine, University of Nevada, Reno, NV 89557, USA; (B.L.B.); (G.W.)
| | - Jay Babu
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89106, USA;
| | - Riyaa Rajesh
- Reno Radiological Associates, Reno, NV 89434, USA; (R.R.); (R.R.); (K.R.)
| | - Rajesh Rangaswamy
- Reno Radiological Associates, Reno, NV 89434, USA; (R.R.); (R.R.); (K.R.)
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3
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Ghallab M, Khairy M, Foster A, Parikh A, Collura G. Severe Disseminated Intravascular Coagulopathy Associated With Biventricular Massive Mural Thrombi in Newly Diagnosed Non-ischemic Cardiomyopathy. Cureus 2023; 15:e39870. [PMID: 37404393 PMCID: PMC10315685 DOI: 10.7759/cureus.39870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
Hemostatic system abnormalities have been previously associated with congestive heart failure (CHF). Here, we report a rare case of disseminated intravascular coagulopathy (DIC) in the setting of non-ischemic cardiomyopathy with right atrial and biventricular thrombus. We present a 55-year-old female with a past medical history of bronchial asthma who presented with a six-day history of bilateral leg swelling and dry cough. Her physical examination on admission was significant for signs of biventricular heart failure. Initial workup was significant for elevated pro-brain natriuretic peptide (ProBNP), elevated transaminases, marked thrombocytopenia (19,000/mcL), and coagulopathy with international normalized ratio (INR) of 2.5 and D-dimer of 15,585 ng/mL. Transthoracic echocardiogram (TTE) showed a large mobile right atrial thrombus protruding into the right ventricle and a more adherent left ventricular (LV) thrombus with severely reduced biventricular contractility. Pan CT was done and was significant for multifocal multilobar pulmonary emboli. A lower limb venous duplex was done and revealed extensive bilateral lower limb deep venous thrombosis (DVT). This rare case demonstrates an unusual association between DIC with non-ischemic cardiomyopathy, biventricular thrombus, extensive deep vein thrombosis, and pulmonary embolism (PE). In comparison, there are multiple prior reports for DIC with CHF and LV thrombus. However, our case differs from prior reports in terms of the presence of right atrial and biventricular thrombus. The patient received antibiotics, diuretics, and cryoprecipitate in the setting of persistent low fibrinogen levels. The patient underwent Interventional radiology-guided thrombectomy for extensive pulmonary emboli followed by inferior vena cava (IVC) filter insertion, resulting in the resolution of the right atrial thrombus and extensive decrease of the pulmonary emboli burden. The patient was then given apixaban after normalization of the platelet count and fibrinogen level. Hypercoagulability workup was inconclusive. The patient was then discharged after improvement of symptoms. Early recognition of DIC and cardiac thrombi in patients with new-onset heart failure is crucial for the implementation of the correct management by thrombectomy, optimizing heart failure medications, and anticoagulation to achieve better outcomes.
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Affiliation(s)
- Muhammad Ghallab
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City (NYC) Health and Hospitals, Queens, New York, USA
- Cardiovascular Medicine, Cairo University, Cairo, EGY
| | - Mahmoud Khairy
- Internal Medicine, Queens Hospital Center, New York, USA
| | - Allison Foster
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City (NYC) Health and Hospitals, Queens, New York, USA
| | - Avish Parikh
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City (NYC) Health and Hospitals, Queens, New York, USA
| | - Giovina Collura
- Cardiology, Icahn School of Medicine at Mount Sinai, New York City (NYC) Health and Hospitals, Queens, New York, USA
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Bertolucci LH, Donadello Martins AP, Rockenbach Pereira O, Schulte AA, Perini SC. Thromboaspiration of Abdominal Aortic Mural Thrombus: A New Endovascular Approach. Vasc Endovascular Surg 2023:15385744231154328. [PMID: 36710000 DOI: 10.1177/15385744231154328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Primary aortic mural thrombus (PAMT) is defined as a thrombus attached to the aortic wall in the absence of any atherosclerotic or aneurysmal disease in the aorta and a cardiac source of embolus. There is no consensus on the ideal treatment of PAMT. There are a few reports of thromboaspiration of aortic thrombus in literature. The objective of this article is to report a new endovascular approach of abdominal aortic mural thrombus. The use of Penumbra Thromboaspiration System is a feasible procedure to treat abdominal aortic thrombus and may be an option for patients unsuitable for open repair or conservative treatment.
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Affiliation(s)
- Leonardo H Bertolucci
- Medical School, 28102Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ana P Donadello Martins
- Medical School, 28102Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Oscar Rockenbach Pereira
- Vascular Surgery Department, 601980Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Alfredo A Schulte
- Vascular Surgery Department, 601980Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Sílvio C Perini
- Vascular Surgery Department, 601980Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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5
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Affiliation(s)
- Kohei Kawai
- Department of Cardiology, Kyoto Yamashiro General Medical Center, Japan
| | - Ryoetsu Yamanaka
- Department of Cardiology, Kyoto Yamashiro General Medical Center, Japan
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6
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Muacevic A, Adler JR, Chiluveri M, McClish J. A Ticking Time Bomb: A Case of Floating Distal Aortic Arch Intraluminal Thrombus. Cureus 2022; 14:e32212. [PMID: 36620847 PMCID: PMC9812528 DOI: 10.7759/cureus.32212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 12/09/2022] Open
Abstract
Aortic arch thrombus is a rare entity that can result in catastrophic sequelae. This is a case report of a 65-year-old female patient who presented with chest pain that started one day prior to arrival at the emergency department. Acute coronary syndrome (ACS) and pulmonary embolism (PE) were ruled out. A filling defect at the distal aortic arch evident on chest computed tomography angiography (CTA) was confirmed to be a floating distal aortic arch thrombus on transesophageal echocardiogram (TEE). There was no evidence of an underlying aneurysm, dissection, or significant atherosclerosis. The patient was considered to be at high risk for surgical intervention, hence, a decision was made to start the patient on chronic anticoagulation with direct oral anticoagulants (DOACs). A follow-up CTA three months later showed total resolution of the thrombus. The report highlights this treacherous pathology and provides an overview of the predisposing factors, radiologic findings, as well as management strategies for floating aortic arch thrombi.
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7
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Nguyen Q, Ma X, Vervoort D, Luc JGY. Management Strategies for Descending Thoracic Aortic Thrombus: A Review of the Literature. Innovations (Phila) 2022; 17:283-296. [PMID: 35866207 PMCID: PMC9403384 DOI: 10.1177/15569845221107011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Descending thoracic aortic thrombus (DTAT) is an under-recognized source of
systemic emboli with potential catastrophic consequences. Imaging modalities
such as echocardiography, computed tomography, magnetic resonance imaging, and
angiography can help identify and characterize the extent of embolic events.
Established guidelines regarding the management of DTAT are currently lacking.
Multiple treatment modalities are available; however, the effectiveness of each
approach remains to be determined. In this study, we performed a review to
examine the clinical presentation, diagnostic methods and findings, and outcomes
of various treatment options for patients with DTAT. Medical management is the
least invasive and most frequently chosen initial approach, offering a high
reported success rate, whereas endovascular therapy can have a role in thrombus
exclusion should conservative management fail.
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Affiliation(s)
- Quynh Nguyen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Xiya Ma
- Faculty of Medicine, Université de Montréal, QC, Canada
| | - Dominique Vervoort
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, ON, Canada
| | - Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, 8166University of British Columbia, Vancouver, BC, Canada
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8
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Doraiswamy V, Vengudusamy S, Arumugam J. Rare presentation of eosinophilic granulomatosis polyangiitis with left ventricular endomyocardial fibrosis in a child. Cardiol Young 2022; 33:1-3. [PMID: 35575300 DOI: 10.1017/s104795112200155x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Eosinophilic granulomatosis polyangiitis represents less than 2% of vasculitis cases in childhood. Children have worse long-term outcomes and higher mortality. Cardiac involvement portends a worse prognosis. We describe here an adolescent girl who presented with heart failure and stroke. Her blood investigations showed eosinophilia and high IgE levels. Cardiac evaluation revealed myocarditis, intracardiac thrombus, and endomyocardial fibrosis, a rare presentation of this disease in childhood.
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Affiliation(s)
- Vinoth Doraiswamy
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore 641004, Tamil Nadu, India
| | - Sivakumar Vengudusamy
- Department of Rheumatology, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore 641004, Tamil Nadu, India
| | - Jayavardhana Arumugam
- Department of Pediatrics, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore 641004, Tamil Nadu, India
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9
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Jonjev ZS, Zdravkovic R, Todic M, Dudas V, Rajic J. Himalayan P wave in a patient admitted for cardiac surgery. J Card Surg 2021; 36:1548-1549. [PMID: 33586238 DOI: 10.1111/jocs.15438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/07/2021] [Indexed: 11/28/2022]
Abstract
Giant or Himalayan P waves are tall and peaked, the most prominent in lead II, and generally indicate enlargement of the right atrium. It has been rarely seen in clinical practice. The mechanism of Himalayan P wave formation is most likely related with prolonged conduction of electrical impulses through the enlarged right atrium. We describe the case of a patient with Himalayan P wave admitted for cardiac surgery.
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Affiliation(s)
- Zivojin S Jonjev
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Ranko Zdravkovic
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Mirko Todic
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Vanja Dudas
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Jovan Rajic
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
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10
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Davidovich RM, Mathews BM, Iqbal Z, Jean XV, Sutter HA, Almassi GH, Pagel PS. A Figure of Eight and a Circle Within a Circle: Is This Left Ventricular Geometry Responsible for Multiple Embolic Strokes Two Years After Inferior Wall Myocardial Infarction? J Cardiothorac Vasc Anesth 2020; 35:1892-1896. [PMID: 33191043 DOI: 10.1053/j.jvca.2020.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Ryan M Davidovich
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Benjamin M Mathews
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Zafar Iqbal
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Xavier V Jean
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Heather A Sutter
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - G Hossein Almassi
- Cardiothoracic Surgery Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI
| | - Paul S Pagel
- Anesthesiology Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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11
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Abstract
INTRODUCTION Neurosyphilis is a chronic infection of the central nervous system that is commonly found in adult with long latency periods. Neurosyphilis-attributed deaths in young patients have grown exponentially in the past decade, yet there have been few studies on the early stages of neurosyphilis. PATIENT CONCERNS A young male patient with syphilitic cerebral arteritis was evaluated in our clinic for the clinical signs of progressive ischemic stroke. DIAGNOSIS The progression of syphilitic cerebral arteritis was observed through computed tomography imaging, magnetic resonance imaging, magnetic resonance angiogram, and transcranial color Doppler. The pathological changes and clinical outcomes were reviewed. In this specific case, the development of syphilitic cerebral arteritis was dynamic, continuous, and rapid. The pathogenesis was related to Heubner arteritis, in which the formation of a mural thrombus (MT) causes the severe obstruction of blood flow without complete occlusion, leading to an increased risk of infarction. In this patient, formation of the MT resulted in the infarction of the smaller vessels and narrowing of the larger vessels. The partial dislodgment of the MT from the arterial wall of the larger vessels occluded the smaller vessels, leading to infarction. INTERVENTIONS Standard pharmacotherapy for the treatment of the cerebral infarction and a single course of penicillin were applied. OUTCOMES Muscle strength was recovered. The Glasgow Coma Scale score was 15, whereas the NIH Stroke Scale score was 0. The increase in blood flow of the right MCA was accompanied by severe stenosis with compensation of the anterior communicating artery. In addition, moderate to severe stenosis of the right vertebral artery and the basilar artery was suspected. There was a possibility that the right posterior communicating artery was recruited for compensation. CONCLUSION Progressive stroke was the initial symptom of the neurosyphilis. Disease progression is rapid and difficult to control with a single course of penicillin.
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Affiliation(s)
- Min Shi
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Yuan Zhou
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Yadi Li
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Yuting Zhu
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, PR China
| | - Bing Yang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, PR China
| | - Li Zhong
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, PR China
| | - Rui Pan
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, PR China
| | - Dongdong Yang
- Hospital of Chengdu University of Traditional Chinese Medicine
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12
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Tsilimparis N, Spanos K, Debus ES, Rohlffs F, Kölbel T. Technical Aspects of Using the AngioVac System for Thrombus Aspiration From the Ascending Aorta. J Endovasc Ther 2018; 25:550-553. [PMID: 30079784 DOI: 10.1177/1526602818792568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To present the technique for removing mural thrombus from the ascending aorta using the AngioVac System. TECHNIQUE The technique is demonstrated in a 66-year-old woman who presented with free-floating mural thrombus in the ascending aorta and was considered unsuitable for either open (comorbidities) or endovascular approaches (high risk of stroke). Because of the free-floating thrombus, the Angiovac system was suggested, although it is approved for only the venous system. The technique was adapted for the arterial system with the 2 access points being (1) the proximal left subclavian artery with a 10-mm conduit for device access and (2) the right femoral vein. The AngioVac cannula and the reinfusion cannula were inserted into the artery and vein, respectively. The extracorporeal bypass circuit was created, and the carotid arteries were clamped during aspiration (<1 minute). The mural thrombus was aspirated successfully. The patient had an uneventful postoperative course with no signs of free thrombus on the postoperative or follow-up computed tomography angiograms. CONCLUSION The use of the AngioVac System seems to be a feasible technique for aspiration of thrombus from the ascending aorta. Expanding this therapeutic option for patients unsuitable for open or endovascular repair may be proven efficient in the near future.
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Affiliation(s)
- Nikolaos Tsilimparis
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | - Konstantinos Spanos
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | - E Sebastian Debus
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | - Fiona Rohlffs
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | - Tilo Kölbel
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
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13
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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. Ann Transl Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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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14
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Gish DS, Baer JA, Crabtree GS, Shaikh B, Fareedy SB. Impending aortic aneurysm rupture - a case report and review of the warning signs. J Community Hosp Intern Med Perspect 2016; 6:32217. [PMID: 27802850 PMCID: PMC5087263 DOI: 10.3402/jchimp.v6.32217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/06/2016] [Accepted: 08/11/2016] [Indexed: 11/14/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) may present with subtle clinical findings. Recognition of the imaging features of an impending rupture is key for timely diagnosis. This report reviews the classic computed tomography findings of impending AAA rupture and presents a recent case which illustrates the key features.
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Affiliation(s)
- David S Gish
- Department of Medicine, The Reading Hospital and Medical Center, West Reading, PA, USA;
| | - J Austin Baer
- Department of Medicine, The Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Gordon S Crabtree
- Department of Medicine, The Reading Hospital and Medical Center, West Reading, PA, USA
| | - Bilal Shaikh
- Department of Medicine, The Reading Hospital and Medical Center, West Reading, PA, USA
| | - Shoaib B Fareedy
- Department of Medicine, The Reading Hospital and Medical Center, West Reading, PA, USA
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15
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Boufi M, Rancic Z. Commentary: Stent-Graft to Treat Specific Ascending Aorta Pathology: Waiting for the Instructions for Use. J Endovasc Ther 2016; 23:973-975. [PMID: 27708142 DOI: 10.1177/1526602816672413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mourad Boufi
- APHM, Department of Vascular Surgery, University Hospital Nord, Marseille, France .,Aix-Marseille Université, IFSTTAR, UMR T24, Marseille, France
| | - Zoran Rancic
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland
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16
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Kahlberg A, Montorfano M, Cambiaghi T, Bertoglio L, Melissano G, Chiesa R. Endovascular Stent-Grafting of the Ascending Aorta for Symptomatic Parietal Thrombus. J Endovasc Ther 2016; 23:969-972. [PMID: 27530412 DOI: 10.1177/1526602816664877] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE To present stent-graft treatment of parietal thrombus in the ascending aorta. CASE REPORT A 64-year-old man with no history of vascular disease developed a right cerebral hemisphere transient ischemic attack and was diagnosed with mural thrombosis of the ascending aorta involving the greater curvature just proximal to the origin of the innominate artery. He was treated for 2 months with anticoagulants, but new imaging studies showed significant increase in the size of the thrombus and an irregular aspect. The thrombus was excluded from the aortic blood flow by deployment of a custom-made stent-graft in the ascending aorta, with embolic protection of the right internal carotid artery. At 6 months, the patient was well, and the thrombus in the ascending aorta appears to be completely excluded by the stent-graft. CONCLUSION In highly selected cases, custom-made thoracic stent-grafts may be used for stabilization and exclusion of symptomatic ascending aorta parietal thrombosis to prevent progression and recurrent embolization.
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Affiliation(s)
- Andrea Kahlberg
- Department of Vascular Surgery, Scientific Institute H. San Raffaele, Vita Salute San Raffaele University, Milan, Italy
| | - Matteo Montorfano
- Department of Interventional Cardiology, Scientific Institute H. San Raffaele, Vita Salute San Raffaele University, Milan, Italy
| | - Tommaso Cambiaghi
- Department of Vascular Surgery, Scientific Institute H. San Raffaele, Vita Salute San Raffaele University, Milan, Italy
| | - Luca Bertoglio
- Department of Vascular Surgery, Scientific Institute H. San Raffaele, Vita Salute San Raffaele University, Milan, Italy
| | - Germano Melissano
- Department of Vascular Surgery, Scientific Institute H. San Raffaele, Vita Salute San Raffaele University, Milan, Italy
| | - Roberto Chiesa
- Department of Vascular Surgery, Scientific Institute H. San Raffaele, Vita Salute San Raffaele University, Milan, Italy
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Jordan WD, de Vries JPPM, Ouriel K, Mehta M, Varnagy D, Moore WM, Arko FR, Joye J, Henretta J. Midterm outcome of EndoAnchors for the prevention of endoleak and stent-graft migration in patients with challenging proximal aortic neck anatomy. J Endovasc Ther 2016; 22:163-70. [PMID: 25809354 DOI: 10.1177/1526602815574685] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore the use of EndoAnchors as an adjunct to endovascular abdominal aortic aneurysm repair for prevention of proximal neck complications in patients with challenging neck anatomy. METHODS Over a 28-month period, 208 patients (159 men; mean age 72±8 years) were enrolled in the ANCHOR prospective, multicenter registry (ClinicalTrials.gov; identifier NCT01534819) for prophylaxis against proximal neck complications. Patients were eligible when, in the opinion of the investigators, they were at increased risk for type Ia endoleak or migration owing to a hostile neck (length <10 mm, diameter >28 mm, angulation >60°, mural thrombus or calcium >2 mm in thickness or >180° in circumference, or conical shape). Overall, 123/157 (78.3%) patients met the criteria for a hostile neck according to core laboratory assessment of 157 adequate preoperative computed tomographic (CT) images. RESULTS Implantation of EndoAnchors was technically successful in 204/208 (98.1%) patients. The frequency of fracture was 0.3% (3/1118); there were no clinical sequelae associated with the fractures. Over the mean 14-month follow-up, 95.2% of patients were alive, and no deaths were attributable to EndoAnchors. There were no ruptures, migrations, or open surgical conversions. Aneurysm-related reinterventions were performed in 8 (3.8%) patients. Among 130 patients with postprocedure contrast CT studies, core laboratory analysis identified 2 (1.5%) patients with type Ia endoleaks. Aneurysm sac diameter decreased >5 mm in 42.9% of patients with CT scans at or beyond 1 year; 1.6% of patients developed sac enlargement >5 mm. CONCLUSION Prophylactic EndoAnchor use for challenging aortic neck anatomy was associated with satisfactory midterm results.
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Affiliation(s)
| | | | | | | | - David Varnagy
- Vascular Institute of Central Florida, Orlando, FL, USA
| | | | | | - James Joye
- El Camino Hospital, Mountain View, CA, USA
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