Himanshu Verma, Robbie George, Ramesh K. Tripathi
Vascular Surgery, Narayana Hrudayalaya Hospital, Bangalore, India.
OBJECTIVES: To report our experience of thromboembolic disease from non-aneurysmal/atherosclerotic aorta.
METHODS: A retrospective review of 63 patients with acute embolic lower limb or visceral ischemia from January 2012 to December 2012 revealed 10 patients (M:F=4:6)(mean age 39.2 years) with a major thrombo-emboligenic source within an otherwise normal aorta after thorough evaluation of heart and great vessels. In 4 patients, thrombus was located in thoracic aorta, 2 in supra-renal abdominal aorta involving visceral vessels and 4 in infra-renal aorta. End organs affected by acute ischemia were: lower limbs (7) (2 bilateral)(L:R =3:6), visceral (3) (R Renal 1; SMA 2; Coeliac 3)
Thrombus involving thoracic aorta (n=4) were treated with a stent-graft. In supra-renal abdominal aorta, both patients underwent laparotomy with trapdoor aortic thrombo-embolectomy ( Figure 1). Of the 3 patients with infra renal aortic thrombus, 1 underwent covered stenting, 1 underwent open aortic thrombectomy with interposition graft and 1 was managed on oral anticoagulants. Post-thrombectomy, there was no underlying aortic wall defect.
RESULTS: One patient with small bowel and ascending colonic ischemia required massive bowel resection died of sepsis and multiorgan failure, and 1 patient needed a below-knee amputation for irreversible ischemia. No patient had any further embolic episode at a median follow up of 160 days.
CONCLUSIONS: Non-atherosclerotic-non-aneurysmal aortic thrombus is an uncommon but important source of non-cardiogenic embolus. It appears to occur in young adults. Coverage of the aortic thrombus with a stent-graft, when feasible, appears to be an effective and safe procedure. When the thrombus lies adjacent to visceral vessels an open trapdoor aortic thrombectomy, under direct visualization, is an effective solution to deal with the acute ischemia and its cause.
AUTHOR DISCLOSURES: R. George: Nothing to disclose; R. K. Tripathi: Nothing to disclose; H. Verma: Nothing to disclose.
Posted April 2013