AORTIC MURAL THROMBUS
DOI:
https://doi.org/10.48729/pjctvs.145Abstract
Aortic mural thrombus is a rare clinical finding in the absence of aneurysm or atherosclerosis but an important source of noncardiogenic emboli with a difficult diagnosis and a high rate of complications, including high mortality. It appears to occur more frequently in young adults usually with underlying pro-thrombotic disorder. With the increasing use of high resolution imaging, the asymptomatic mural thrombus became an increasingly frequent finding, but its potential for embolization or the best treatment are still a matter of debate. The management of mural thrombus in non-atherosclerotic aorta represents a challenge because no guidelines are available, and should be individualized. The therapeutic approach should include the triple aspects of aortic mural thrombus: primary disease anticoagulation treatment, surgical thrombectomy to solve embolic complications and endovascular/classical surgery to exclude the thrombus from the aorta. Historically therapeutic anticoagulation was proposed as first-line therapy and surgical intervention was reserved for mobile thrombus, recurrent embolism and contraindication for anticoagulation. However, it is associated with a 25-50% embolic recurrence rate, thrombus persistence in 35% and secondary aortic surgery in up to 31% of the cases. Recent data suggest that endovascular coverage of the aortic thrombus, when feasible, appears to be an effective and safe procedure with a low recurrence and re-embolization rates. In this article we review the published literature concerning this topic.
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Machleder H1, Takiff H, Lois JF et al. Aortic mural thrombus: an occult source of arterial thromboembolism. J Vasc Surg. 1986;4:473-8.
Piffaretti G, Tozzi M, Caronno R, et al. Endovascular treatment for mobile thrombus of the thoracic aorta. Eur J Cardiothorac Surg 2007;32:664e6.
Bowdish ME, Weaver FA, Liebman HA, et al. Anticoagulation is an effective treatment for aortic mural thrombi. J Vasc Surg 2002;36:713e9.
Turley RS, Unger J, Cox MW, et al. Atypical Aortic Thrombus: Should Nonoperative Management Be First Line? Ann Vasc Surg 2014;28:1610-1617.
Noel, Antoine, et al. Recurrent systemic embolism caused by descending thoracic aortic mural thrombus in a young cannabis abuser. Journal of Cardiology Cases 13.3 (2016): 93-95.
Roche-Nagle G, Wooster D, & Oreopoulos G. Symptomatic Thoracic Aorta Mural Thrombus. Vascular. 2010;18(1), 41–44.
Williams GM, Harrington D, Burdick J. Mural thrombus of the aorta: an importante, frequently negleteed cause of large peripheral emboli. Ann Surg 1981; 194:737-44.
Moris D, Karaolanis G, Schizas D. eComment. Mural thrombus in normal appearing aorta: Unfinished saga in uncharted waters. Interact Cardiovasc Thorac Surg. 2016 Mar;22(3):373-4.
Onwuanyi A, Sachdeva R, Hamirani K, et al. Multiple aortic thrombi associated with protein C and S deficiency. Mayo Clin Proc 2001;76:319e22.
Cogert G, Siegel RJ. Giant floating aortic thrombus: a rare finding on transesophageal echocardiography. Am J Cardiol 2007;99:739e40.
Kloppenburg GT, Sonker U, Schepens MA. Intra-aortic balloon pump related thrombus in the proximal descending thoracic aorta with peripheral emboli. J Invasive Cardiol 2009;21: e110e2.
Ryu YG, Chung CH, Choo SJ, et al. A case of anti- phospholipid syndrome presenting with a floating thrombus in the ascending aorta. J Thorac Cardiovasc Surg 2009;137:500e2.
Rafiq MU, Jajja MM, Qadri SS, et al. An unusual presentation of pedunculated thrombus in the distal arch of the aorta after splenectomy for B-cell lymphoma. J Vasc Surg 2008;
Hazirolan T, Perler BA, Bluemke DA. Floating thoracic aortic thrombus in “protein S” deficient patient. J Vasc Surg
;40: 381.
Tsiliparis N, Hanack U, Pisimisis G. Thrombus in the Non-aneurysmal, Non-atherosclerotic Descending Thoracic Aorta e An Unusual Source of Arterial Embolism. Eur J Vasc Endovasc Surg (2011) 41, 450-457.
Beldi G, Bissat A, Eugster T, et al. Mural thrombus of the aorta in association with homozygous plas- minogen activator
inhibitor type 1 (PAI-1)-675(4G) and hetero- zygous GP Ia 807C/T genotypes. J Vasc Surg 2002;36:632-4.
Schattner A. Meital A. Mobile Menace: Floating aortic arch thrombus. American Journal of Medicine; 2016;129;e24.
Yagyu T, Naito M, Kumada M, et al. Aortic Mural Thrombus in the Non-Atherosclerotic Aorta of Patients with Multiple Hypercoagulable Factors. Intern Med Advance Publication 2018 Sep; DOI: 10.2169/internalmedicine.0691-17
Aparci M, Uz O, Atalay M. eComment. An unusual cause of aortic mural thrombus in non-atherosclerotic vessel. Interact CardioVasc Thorac Surg 2016;22:371–4.
Laperche T, Laurian C, Roudaut R. Mobile thromboses of the aortic arch without aortic debris. A transesophageal echocardiographic
finding associated with unexplained arterial embolism. Teh Filiale Echocardiographie de la Societe Fancaise de Cardiologie. Circulation 1997; 96:288-94.
Weiss S, Buhlmann R, von Allmen RS, et al. Management of floating thrombus in the aortic arch. J Thorac Cardiovasc Surg 2016; 152:810-7.
Meyermann K., Trani J., Caputo F.J. et al. Descending thoracic aortic mural thrombus presentation and treatment strategies. J Vasc Surg. 2017;66:931-6
Verma H, Meda N, Vora S, et al. Contemporary management of symptomatic primary aortic mural thrombus. J Vasc Surg 2014; 60:1524-34.
Fayad ZY, Semaan E, Fahoum B, et al. Aortic Mural Thrombus in the normal or minimally Atherosclerotic Aorta. Ann Vasc Surg 2013;27:282-290.
Boufi M, Mameli A. Compes P. Elective Stent-graft Treatment for the Management of Thoracic Aorta Mural Thrombus. 2014; 47(4): 335–341
Oyewole-Eletu S, Mursleen A, Chung CJ, Page JP. Seven centimeter aortic mural thrombus in a 40-year-old female: Review and management. J Case Rep Images Med 2017;3:42–45.
Maloberti A, Oliva F, De Chiara B, et al. Asymptomatic aortic mural thrombus in a minimally atherosclerotic vessel. Interact
CardioVasc Thorac Surg 2016;22:371–4.
Karalis DG. Chandrasekaran K. Victor MF. Recognition amd embolic potential of intraaortic atherosclerotic debris. J Am Coll Cardiol. 1991;17:73-8.
Ungprasert P, Ratanapo S, Cheungpasitporn W. Management in thoracic aorta mural thrombi: Evidence based medicine
and controversy. Emergency Medicine 1 (2011): e104.
Aldaher MK, El-Fayed HM, Malouka SA, et al. Large aortic arc mural thrombus in non-atherosclerotic thoracic aorta – a rare cause of stroke in the young. BMJ Case Rep 2015.
Choukroun EM, Labrousse LM, Madonna FP, et al. Mobile thrombus of the thoracic aorta: diagnosis and treatment in
cases. Ann Vasc Surg 2002; 16:714-22.
Hanh TL, Dalsing MC. Sawchuk AP, et al. Primary aortic mural thrombus: presentation and treatment. Ann Vasc Surg 1999; 13:52-9.
Iyer AP, Sadasivan D, Kamal U, et al Resolution of large intra-aortic thrombus following anticoagulation therapy. Heart Lung Circ 2009;18:49e50.
Valdivia AR, Duque Santos A, Urena MG, et al. Anticoagulation Alone for Aortic Segment Treatment in Symptomatic Primary Aortic Mural Thrombus Patients; Ann Vasc Surg. 2018;43:121–26.
Lau LS, Blanchard DG, Hye RJ. Diagnosis and management of patients with peripheral macroemboli from thoracic aortic pathology. Ann Vasc Surg. 1997;11:348-53.
Pasierski T, Jasek S, Firek B, et al. Resolution of an aortic mobile mass with anticoagulation without evidence of arterial embolism. Clin Cardiol 1996;19:151–2.
Kruger T, Liske B, Ziemer S, et al. Thrombolysis to treat thrombi of the aortic arch. Clin Appl Thromb Hemost. 2011;17:340–345 ([Case Reports]).
Hausmann D, Gulba D, Bargheer K, et al, Successful thrombolysis of an aortic-arch thrombus in a patient after mesenteric embolism. N Engl J 25 Med. 1992;327:500–501 ([Case Reports Letter]).
Tsilimparis N, Spanos K, Sebastian Debus E, et al. Technical Aspects of Using the AngioVac System for Thrombus Aspiration From the Ascending Aorta. Journal of Endovascular Therapy. 2018;25(5), 550–553.
Dougherty MJ, Calligaro KD, Rua I, et al, Idiopathic pedunculated mural thrombus of the nonaneurysmal infrarenal aorta presenting with popliteal embolization: two cases treated with thrombolytic therapy. J Vasc Surg. 2000;32:383–387 ([Case Reports]).
Luebke T, Aleksic M, Brunkwall J. Endovascular therapy of a symptomatic mobile thrombus of the thoracic aorta. Eur J Vasc Endovasc Surg. 2008; 36:550e2.
Zhang WW, Abou-Zamzam AM, Hashisho M, et al. Staged endovascular stent grafts for concurrent mobile/ulcerated thrombi of thoracic and abdominal aorta causing recurrent spontaneous distal embolization. J Vasc Surg 2008;47:193e6.
Altenbernd J, Schurmann K, Walterbusch G. Stent-graft therapy in a mobile thrombus in the thoracic aorta. Rofo 2008;180:158e9.
Fueglistaler P, Wolff T, Guerke L, et al. Endovascular stent graft for symptomatic mobile thrombus of the thoracic aorta. J Vasc Surg 2005;42:781e3.
Rancic Z, Pfammatter T, Lachat M, et al. Floating aortic arch thrombus involving the supraaortic trunks: successful treatment with supra-aortic debranching and antegrade endograft implantation. J Vasc Surg 2009;50: 1177-80.
Jeyabalan G, Wallace JR, Chaer RA, et al. Endovascular strategies for treatment of embolizing thoracoabdominal aortic lesions. J Vasc Surg. 2014;59(5):1256-64.
Sabetai, MM, Conway, .M, Hallward, G, Bapat, V. Ascending aorta thrombus adjacent to a cholesterol-rich plaque as the source of multiple emboli. Interact Cardiovasc Thorac Surg. 2013;16:389–390.
Kalangos A, Baldovinos A, Vuille C, et al. Floating thrombus in the ascending aorta: a rare cause of peripheral emboli. J Vasc Surg. 1997;27:150–154.
Choi JB, Choi SH, Kim NH, et al. Floating thrombus in the proximal aortic arch. Tex Heart Inst J. 2004;31:432–434.
Sawada T, Shimokawa T. Giant thrombus in the ascending aorta that caused systemic embolism. Interact Cardiovasc Thorac Surg. 2011;12:1048–1050.
Pang, Philip YK, and Viswa B. Nathan. Successful Thrombectomy for an Idiopathic Floating Ascending Aortic Thrombus. The Annals of Thoracic Surgery 102.3 (2016): e245-e247.
Calderon, P., Heredero, A., Pastor, A. et al. Successful removal of a floating thrombus in ascending aorta. Ann Thorac Surg. 2011;91:e67–e69.
De Rango, P. Mural thrombus of thoracic aorta: few solutions and more queries. European Journal of Vascular and Endovascular Surgery 41.4 (2011): 458-459.
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