Protruding aortic arch thrombus: Treatment with minimally invasive surgical approach
| Autor: | Morag B, Raphael Walden, Alex Garniak, Eitan Heldenberg, Hana Fenigstein, Ehud Schwammenthal, Micha S. Feinberg, Jacob Schneiderman, Alex Tenenbaum, Raphael Adar |
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| Rok vydání: | 2004 |
| Předmět: |
Male
Aortic arch medicine.medical_specialty medicine.medical_treatment Aortic Diseases Embolectomy Balloon medicine.artery medicine Humans Minimally Invasive Surgical Procedures cardiovascular diseases Thrombus Thrombectomy Aorta Aortic Arch Syndromes business.industry Balloon catheter Thrombosis Middle Aged medicine.disease Surgery Treatment Outcome Descending aorta Aortic Arch Syndrome cardiovascular system Female Radiology Cardiology and Cardiovascular Medicine business Echocardiography Transesophageal |
| Zdroj: | Journal of Vascular Surgery. 40:1083-1088 |
| ISSN: | 0741-5214 |
| DOI: | 10.1016/j.jvs.2004.09.014 |
| Popis: | Background Protruding aortic arch thrombus is associated clinically with life-threatening emboli. Definitive treatment for aortic arch thrombus removal has demanded complicated vascular surgical procedures, with high morbidity and mortality. Methods and results Transesophageal echocardiography (TEE) enabled diagnosis of a protruding thrombus at the aortic arch in 5 patients, and a simultaneous lesion in the descending aorta in 1 patient. Four patients had visceral emboli, coinciding with peripheral emboli in 2 patients, and the fifth patient had peripheral and cerebral emboli. One patient had had ischemic stroke and femoral emboli a few months previously. Mean patient age was 51 years. None had clinical evidence of coronary or peripheral atherosclerotic occlusive disease. Risk factors included hypertension (n = 2), smoking (n = 4), and preexisting thrombophilia (n = 4). Five patients underwent TEE-guided aortic balloon thrombectomy from the arch with a 34-mm occluding balloon catheter. One patient also underwent balloon thrombectomy from the descending aorta with a 14F Foley catheter. Access into the aorta was obtained through the iliac artery (n = 4) during laparotomy because of visceral ischemia or through the transfemoral approach (n = 2). Previous procedures included superior mesenteric embolectomy (n = 3), segmental bowel resection (n = 1), splenectomy (n = 1), and peripheral arterial embolectomy n=3). Real-time intraoperative TEE enabled visualization of the protruding thrombus and assisted with maneuvering of the balloon catheter. At completion peripheral thrombectomy thrombus material was retrieved in 4 patients. Postoperatively there were no clinically proved new procedure-related visceral emboli, and all patients received anticoagulant therapy thereafter. Follow-up TEE within 2 weeks and up to 7 years revealed no recurrent aortic arch thrombus. Conclusions TEE-guided aortic balloon thrombectomy used in 6 procedures was effectively completed without visceral or peripheral ischemic complications. It enabled removal of the life-threatening source of emboli from the proximal aorta, thereby averting the need of major aortic surgery. |
| Databáze: | OpenAIRE |
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