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Contemporary management of symptomatic primary aortic mural thrombus

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Presentation on theme: "Contemporary management of symptomatic primary aortic mural thrombus"— Presentation transcript:

1 Contemporary management of symptomatic primary aortic mural thrombus
Himanshu Verma, MBBS, MS, FEVS, Narendranadh Meda, MBBS, MS, Simit Vora, MBBS, MS, Robbie K. George, MS, DNB, FRCS, Ramesh K. Tripathi, MD, FRCS, FRACS  Journal of Vascular Surgery  Volume 60, Issue 6, Pages (December 2014) DOI: /j.jvs Copyright © 2014 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Institutional protocol for investigating acute arterial thrombosis. CTA, Computed tomography angiography; ECG, electrocardiography; MRA, magnetic resonance angiography. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Classification of primary aortic mural thrombus (PAMT). DTA, Descending thoracic aorta; SCA, subclavian artery. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Yield of hypercoagulable workup in patients with primary aortic mural thrombus (PAMT). ∗One patient had combined protein C and protein S deficiency. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Floating aortic arch thrombus involving supra-aortic vessels (type Ib primary aortic mural thrombus [PAMT]) (a) that was managed by supra-aortic debranching and antegrade endograft implantation (b). (Reproduced from Rancic Z, Pfammatter T, Lachat M, Frauenfelder T, Veith FJ, Mayer D. Floating aortic arch thrombus involving the supraaortic trunks: successful treatment with supra-aortic debranching and antegrade endograft implantation. J Vasc Surg 2009;50: © Elsevier 2009.) Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Type IIa primary aortic mural thrombus (PAMT). a and b, Preoperative computed tomography (CT) scan showing pedunculated thrombus distal to left subclavian artery. c, Intraoperative angiogram showing shadow of thrombus (arrows). d, Six-month follow-up CT scan showing complete exclusion of thrombus. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

7 Fig 6 Type IIb primary aortic mural thrombus (PAMT). a, Preoperative computed tomography (CT) scan showing type IIb pedunculated thrombus. b, Six-month follow-up CT scan shows complete exclusion of thrombus by 22- × 70-mm Wallstent (Boston Scientific, Watertown, Mass). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

8 Fig 7 Trapdoor thrombectomy for type III primary aortic mural thrombus (PAMT). a and b, Preoperative computed tomography (CT) scan showing type III PAMT (arrow) in coronal and saggital sections. c, Medial visceral rotation and supraceliac aortic dissection until diaphragmatic crus (1). Silastic loop control of celiac trunk (2), superior mesenteric artery (3), and right (4) and left (5) renal arteries. Incision line for trapdoor aortotomy (dotted line) could extend inferiorly if thrombus extends below in infrarenal aorta. d, Intraluminal thrombus is seen after trapdoor aortotomy (arrow). Aortic thrombectomy and embolectomy from individual visceral vessel could be performed. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

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