Aortik Trombüs
Özet
Kardiyak kökenli olmayan embolilerin önemli bir kaynağı olan aortik trombüsler aort lümeni içerisinde aort duvarına yapışık ve çeşitli karakterlere sahip şekilde bulunabilirler. Etyoloji büyük oranda idiyopatik olsa da genellikle altta yatan bir hiperkoagülasyon durumunun olduğu düşünülmektedir. Gerçek insidansı, çoğunlukla asemptomatik seyrettiği için muhtemelen belirtilenlerden çok daha fazladır. Beraberinde getirdiği periferik ve visseral emboli riski nedeniyle mortalite ve morbidite üzerinde ciddiyetini korumaktadır. Emboli olmadan önce yüksek oranda asemptomatik seyirli olduğundan tanı, prognostik değerlendirme veya uygun tedavi konusunda halen net fikir birliği bulunmamaktadır. Bu bölümde aortik trombüsler hakkında genel kanıtlar ışığında tanı, patofizyoloji, klinik prezentasyon ve uygun tedavi seçeneklerine değinilecektir.
Aortic thrombi, which are an important source of emboli of non-cardiac origin, can be present in the aortic lumen adherent to the aortic wall and have various characteristics. Although the etiology is largely idiopathic, an underlying hypercoagulation condition is generally thought to be present. The actual incidence is probably much higher than stated because of the mostly asymptomatic course. Because of the risk of peripheral and visceral embolism it brings with it, mortality and morbidity remain serious. Because of its highly asymptomatic course before embolisation, there is still no clear consensus on the diagnosis, prognostic evaluation or appropriate treatment. In this chapter, diagnosis, pathophysiology, clinical presentation and appropriate treatment options will be discussed in the light of general evidence about aortic thrombi.
Referanslar
Weismann RE, Tobin RW. Arterial embolism occurring during systemic heparin therapy. AMA Arch Surg. 1958;76(2):219-225; discussion 225-217. doi:10.1001/archsurg.1958.01280200041005
Williams GM, Harrington D, Burdick J, et al. Mural thrombus of the aorta: an important, frequently neglected cause of large peripheral emboli. Ann Surg. 1981;194(6):737-744. doi:10.1097/00000658-198112000-00013
Machleder HI, Takiff H, Lois JF, et al. Aortic mural thrombus: an occult source of arterial thromboembolism. J Vasc Surg. 1986;4(5):473-478. doi:10.1016/0741-5214(86)90383-6
Maloberti A, Oliva F, De Chiara B, et al. Asymptomatic aortic mural thrombus in a minimally atherosclerotic vessel. Interact Cardiovasc Thorac Surg. 2016;22(3):371-373. doi:10.1093/icvts/ivv349
Beldi G, Bissat A, Eugster T, et al. Mural thrombus of the aorta in association with homozygous plasminogen activator inhibitor type 1 (PAI-1)-675(4G) and heterozygous GP Ia 807C/T genotypes. J Vasc Surg. 2002;36(3):632-634. doi:10.1067/mva.2002.126549
Hazirolan T, Perler BA, Bluemke DA. Floating thoracic aortic thrombus in "protein S" deficient patient. J Vasc Surg. 2004;40(2):381. doi:10.1016/j.jvs.2003.11.029
Schattner A, Adi M. Mobile Menace: Floating Aortic Arch Thrombus. Am J Med. 2016;129(2):e23-24. doi:10.1016/j.amjmed.2015.07.027
Turley RS, Unger J, Cox MW, et al. Atypical aortic thrombus: should nonoperative management be first line? Ann Vasc Surg. 2014;28(7):1610-1617. doi:10.1016/j.avsg.2014.03.028
Aparci M, Uz O, Atalay M. eComment. An unusual cause of aortic mural thrombus in non-atherosclerotic vessel. Interact Cardiovasc Thorac Surg. 2016;22(3):373. doi:10.1093/icvts/ivv406
Yagyu T, Naito M, Kumada M, et al. Aortic Mural Thrombus in the Non-atherosclerotic Aorta of Patients with Multiple Hypercoagulable Factors. Intern Med. 2019;58(3):381-385. doi:10.2169/internalmedicine.0691-17
Laperche T, Laurian C, Roudaut R, et al. Mobile thromboses of the aortic arch without aortic debris. A transesophageal echocardiographic finding associated with unexplained arterial embolism. The Filiale Echocardiographie de la Societe Francaise de Cardiologie. Circulation. 1997;96(1):288-294. doi:10.1161/01.cir.96.1.288
Varino J, Rodrigues R, Pereira B, et al. [Aortic mural thrombus]. Rev Port Cir Cardiotorac Vasc. 2019;26(1):19-26. doi:10.48729/pjctvs.145
Cicenia M, Fedele F, Petronilli V, et al. Hidden in the heart: A peculiar type of left ventricular remodeling after acute myocardial infarction. Echocardiography (Mount Kisco, NY). 2017;34(11):1738-1739. doi:10.1111/echo.13658
Meyermann K, Trani J, Caputo FJ, et al. Descending thoracic aortic mural thrombus presentation and treatment strategies. J Vasc Surg. 2017;66(3):931-936. doi:10.1016/j.jvs.2017.05.109
Fayad ZY, Semaan E, Fahoum B, et al. Aortic mural thrombus in the normal or minimally atherosclerotic aorta. Ann Vasc Surg. 2013;27(3):282-290. doi:10.1016/j.avsg.2012.03.011
Verma H, Meda N, Vora S, et al. Contemporary management of symptomatic primary aortic mural thrombus. J Vasc Surg. 2014;60(6):1524-1534. doi:10.1016/j.jvs.2014.08.057
Boufi M, Mameli A, Compes P, et al. Elective stent-graft treatment for the management of thoracic aorta mural thrombus. Eur J Vasc Endovasc Surg. 2014;47(4):335-341. doi:10.1016/j.ejvs.2013.11.014
Desouza N, Sood A, Baciewicz FA, et al. Traumatic Aortic Mural Thrombus Diagnosed Echocardiographically before Thoracic Endovascular Aortic Repair. Texas Heart Institute journal. 2018;45(3):188-189. doi:10.14503/THIJ-16-6160
Karalis DG, Chandrasekaran K, Victor MF, et al. Recognition and embolic potential of intraaortic atherosclerotic debris. J Am Coll Cardiol. 1991;17(1):73-78. doi:10.1016/0735-1097(91)90706-f
Tsilimparis N, Hanack U, Pisimisis G, et al. Thrombus in the non-aneurysmal, non-atherosclerotic descending thoracic aorta--an unusual source of arterial embolism. Eur J Vasc Endovasc Surg. 2011;41(4):450-457. doi:10.1016/j.ejvs.2010.11.004
Moris D, Karaolanis G, Schizas D, et al. eComment. Mural thrombus in normal appearing aorta: Unfinished saga in uncharted waters. Interact Cardiovasc Thorac Surg. 2016;22(3):373-374. doi:10.1093/icvts/ivv407
Tsilimparis N, Spanos K, Debus ES, et al. Technical Aspects of Using the AngioVac System for Thrombus Aspiration From the Ascending Aorta. J Endovasc Ther. 2018;25(5):550-553. doi:10.1177/1526602818792568
Luebke T, Aleksic M, Brunkwall J. Endovascular therapy of a symptomatic mobile thrombus of the thoracic aorta. Eur J Vasc Endovasc Surg. 2008;36(5):550-552. doi:10.1016/j.ejvs.2008.07.004
Choukroun EM, Labrousse LM, Madonna FP, et al. Mobile thrombus of the thoracic aorta: diagnosis and treatment in 9 cases. Ann Vasc Surg. 2002;16(6):714-722. doi:10.1007/s10016-001-0314-2
Referanslar
Weismann RE, Tobin RW. Arterial embolism occurring during systemic heparin therapy. AMA Arch Surg. 1958;76(2):219-225; discussion 225-217. doi:10.1001/archsurg.1958.01280200041005
Williams GM, Harrington D, Burdick J, et al. Mural thrombus of the aorta: an important, frequently neglected cause of large peripheral emboli. Ann Surg. 1981;194(6):737-744. doi:10.1097/00000658-198112000-00013
Machleder HI, Takiff H, Lois JF, et al. Aortic mural thrombus: an occult source of arterial thromboembolism. J Vasc Surg. 1986;4(5):473-478. doi:10.1016/0741-5214(86)90383-6
Maloberti A, Oliva F, De Chiara B, et al. Asymptomatic aortic mural thrombus in a minimally atherosclerotic vessel. Interact Cardiovasc Thorac Surg. 2016;22(3):371-373. doi:10.1093/icvts/ivv349
Beldi G, Bissat A, Eugster T, et al. Mural thrombus of the aorta in association with homozygous plasminogen activator inhibitor type 1 (PAI-1)-675(4G) and heterozygous GP Ia 807C/T genotypes. J Vasc Surg. 2002;36(3):632-634. doi:10.1067/mva.2002.126549
Hazirolan T, Perler BA, Bluemke DA. Floating thoracic aortic thrombus in "protein S" deficient patient. J Vasc Surg. 2004;40(2):381. doi:10.1016/j.jvs.2003.11.029
Schattner A, Adi M. Mobile Menace: Floating Aortic Arch Thrombus. Am J Med. 2016;129(2):e23-24. doi:10.1016/j.amjmed.2015.07.027
Turley RS, Unger J, Cox MW, et al. Atypical aortic thrombus: should nonoperative management be first line? Ann Vasc Surg. 2014;28(7):1610-1617. doi:10.1016/j.avsg.2014.03.028
Aparci M, Uz O, Atalay M. eComment. An unusual cause of aortic mural thrombus in non-atherosclerotic vessel. Interact Cardiovasc Thorac Surg. 2016;22(3):373. doi:10.1093/icvts/ivv406
Yagyu T, Naito M, Kumada M, et al. Aortic Mural Thrombus in the Non-atherosclerotic Aorta of Patients with Multiple Hypercoagulable Factors. Intern Med. 2019;58(3):381-385. doi:10.2169/internalmedicine.0691-17
Laperche T, Laurian C, Roudaut R, et al. Mobile thromboses of the aortic arch without aortic debris. A transesophageal echocardiographic finding associated with unexplained arterial embolism. The Filiale Echocardiographie de la Societe Francaise de Cardiologie. Circulation. 1997;96(1):288-294. doi:10.1161/01.cir.96.1.288
Varino J, Rodrigues R, Pereira B, et al. [Aortic mural thrombus]. Rev Port Cir Cardiotorac Vasc. 2019;26(1):19-26. doi:10.48729/pjctvs.145
Cicenia M, Fedele F, Petronilli V, et al. Hidden in the heart: A peculiar type of left ventricular remodeling after acute myocardial infarction. Echocardiography (Mount Kisco, NY). 2017;34(11):1738-1739. doi:10.1111/echo.13658
Meyermann K, Trani J, Caputo FJ, et al. Descending thoracic aortic mural thrombus presentation and treatment strategies. J Vasc Surg. 2017;66(3):931-936. doi:10.1016/j.jvs.2017.05.109
Fayad ZY, Semaan E, Fahoum B, et al. Aortic mural thrombus in the normal or minimally atherosclerotic aorta. Ann Vasc Surg. 2013;27(3):282-290. doi:10.1016/j.avsg.2012.03.011
Verma H, Meda N, Vora S, et al. Contemporary management of symptomatic primary aortic mural thrombus. J Vasc Surg. 2014;60(6):1524-1534. doi:10.1016/j.jvs.2014.08.057
Boufi M, Mameli A, Compes P, et al. Elective stent-graft treatment for the management of thoracic aorta mural thrombus. Eur J Vasc Endovasc Surg. 2014;47(4):335-341. doi:10.1016/j.ejvs.2013.11.014
Desouza N, Sood A, Baciewicz FA, et al. Traumatic Aortic Mural Thrombus Diagnosed Echocardiographically before Thoracic Endovascular Aortic Repair. Texas Heart Institute journal. 2018;45(3):188-189. doi:10.14503/THIJ-16-6160
Karalis DG, Chandrasekaran K, Victor MF, et al. Recognition and embolic potential of intraaortic atherosclerotic debris. J Am Coll Cardiol. 1991;17(1):73-78. doi:10.1016/0735-1097(91)90706-f
Tsilimparis N, Hanack U, Pisimisis G, et al. Thrombus in the non-aneurysmal, non-atherosclerotic descending thoracic aorta--an unusual source of arterial embolism. Eur J Vasc Endovasc Surg. 2011;41(4):450-457. doi:10.1016/j.ejvs.2010.11.004
Moris D, Karaolanis G, Schizas D, et al. eComment. Mural thrombus in normal appearing aorta: Unfinished saga in uncharted waters. Interact Cardiovasc Thorac Surg. 2016;22(3):373-374. doi:10.1093/icvts/ivv407
Tsilimparis N, Spanos K, Debus ES, et al. Technical Aspects of Using the AngioVac System for Thrombus Aspiration From the Ascending Aorta. J Endovasc Ther. 2018;25(5):550-553. doi:10.1177/1526602818792568
Luebke T, Aleksic M, Brunkwall J. Endovascular therapy of a symptomatic mobile thrombus of the thoracic aorta. Eur J Vasc Endovasc Surg. 2008;36(5):550-552. doi:10.1016/j.ejvs.2008.07.004
Choukroun EM, Labrousse LM, Madonna FP, et al. Mobile thrombus of the thoracic aorta: diagnosis and treatment in 9 cases. Ann Vasc Surg. 2002;16(6):714-722. doi:10.1007/s10016-001-0314-2
