Primary aortic mural thrombus

Presentation and treatment

Tara L. Hahn, Michael Dalsing, Alan Sawchuk, Dolores F. Cikrit, Stephen G. Lalka

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

The clinical presentation of patients with acute lower-limb ischemia and primary aortic thrombus prompted this review. Following recognition of the first case in early 1994, relevant patients (n = 6) were kept in a database and were reviewed for presentation, treatment, and follow-up. The median age was 41 and five patients were male. Angiography, computed tomography, and/or magnetic resonance angiography demonstrated one or more aortic sessile or pedunculated thrombus(i) without associated atherosclerotic disease. In two cases, a retropancreatic intraaortic mural thrombus was associated with severe pancreatitis. All other cases presented with acute lower-limb emboli requiring limb salvage embolectomy. Because of significant patient illness, systemic anticoagulation was chosen acutely to prevent recurrent emboli. Interestingly, serial studies demonstrated aortic thrombus resolution. Failure to continue warfarin therapy resulted in recurrent problems (n = 1) unless the instigating event had resolved (n = 3). There were no deaths or amputations. We concluded that surgical embolectomy, when required, with subsequent anticoagulation, results in limb salvage and allows for eventual resolution of the primary aortic thrombus. Long-term anticoagulation is required unless the etiologic process resolves. The literature describes patients with atherosclerosis and overlying thrombus but fails to describe the approach to patients with primary thrombus formation.

Original languageEnglish
Pages (from-to)52-59
Number of pages8
JournalAnnals of Vascular Surgery
Volume13
Issue number1
DOIs
StatePublished - 1999

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Thrombosis
Embolectomy
Limb Salvage
Embolism
Therapeutics
Lower Extremity
Magnetic Resonance Angiography
Warfarin
Amputation
Pancreatitis
Atherosclerosis
Ischemia
Databases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Primary aortic mural thrombus : Presentation and treatment. / Hahn, Tara L.; Dalsing, Michael; Sawchuk, Alan; Cikrit, Dolores F.; Lalka, Stephen G.

In: Annals of Vascular Surgery, Vol. 13, No. 1, 1999, p. 52-59.

Research output: Contribution to journalArticle

Hahn, Tara L. ; Dalsing, Michael ; Sawchuk, Alan ; Cikrit, Dolores F. ; Lalka, Stephen G. / Primary aortic mural thrombus : Presentation and treatment. In: Annals of Vascular Surgery. 1999 ; Vol. 13, No. 1. pp. 52-59.
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