Metrika članka

  • citati u SCindeksu: 0
  • citati u Google Scholaru:[=>]
  • posete u prethodnih 30 dana:0
  • preuzimanja u prethodnih 30 dana:0
članak: 1 od 1  
Medicinski časopis
2017, vol. 51, br. 4, str. 136-139
jezik rada: engleski
vrsta rada: prikaz slučaja
doi:10.5937/mckg51-16433


Slobodni flotirajući tromb u neaterosklertoski, neaneurizmatski izmenjenoj ascendentnoj aorti - redak entitet
aClinical Center 'Kragujevac', Center for Vascular Surgery, Kragujevac
bClinical Center Serbia, Clinic for Vascular and Endovascular Surgery, Belgrade

Sažetak

Pojava slobodnoflotirajućeg tromba (SFT) u morfološki zdravoj ascendentnoj aorti veoma je retko stanje, koje se s pojavom savremenih dijagnostičkih metoda znatno češće otkriva. Jedan od glavnih uzroka ovog stanja jesu hiperkoagulabilni poremećaji, a glavne manifestacije su distalne embolizacije. U ovom radu prikazujemo slučaj pacijenta muškog pola, starosti 59 godina, sa znacima akutne ishemije donjeg ekstremiteta, uzrokovane embolusom iz slobodnog flotirajućeg tromba u ascendentnoj aorti. Embolija je najpre detektovana digitalnom subtrakcionom angiografijom, a kasnije i SFT, kompjuterizovanom tomografijom. Odmah je započeto sa antikoagulantnom terapijom. Nakon hirurškog odstranjenja embolusa iz magistralnih arterija noge, otkriven je hiperkoagulabilni poremećaj. Na kontrolnom CT pregledu nakon 10 dana, nije bilo naznaka trombnih masa u ascendentnoj aorti. Smatramo da je brzo započinjanje antikoagulantne terapije izuzetno značajno i da je u mnogim slučajevima to optimalan način tretmana ovakvih pacijenata sa SFT. Ipak, još nisu sprovedene studije ni istraživanja koja bi ovo potvrdila, niti postoji algoritam postupaka za tretman ovakvih pacijenata.

Ključne reči

Reference

Abbott, W.M., Maloney, R.D., McCabe, C.C., Lee, C.E., Wirthlin, L.S. (1982) Arterial embolism: A 44 year perspective. American Journal of Surgery, 143(4): 460-464
Boekholdt, S., Kramer, M. (2007) Arterial Thrombosis and the Role of Thrombophilia. Seminars in Thrombosis and Hemostasis, 33(6): 588-596
Dee, W., Geibel, A., Kasper, W., Konstantinides, S., Just, H. (1993) Mobile thrombi in atherosclerotic lesions of the thoracic aorta: The diagnostic impact of transesophageal echocardiography. American Heart Journal, 126(3): 707-710
Dykes, A.C., Walker, I.D., McMahon, A.D., Islam, S.I., Tait, R.C. (2001) A study of Protein S antigen levels in 3788 healthy volunteers: Influence of age, sex and hormone use, and estimate for prevalence of deficiency state. Br J Haematol, 113(3): 636-41
Eguchi, K., Ohtaki, E., Misu, K., Aikawa, M., Sumiyoshi, T., Hosoda, S., Koyanagi, T. (2004) Acute myocardial infarction caused by embolism of thrombus in the right coronary sinus of valsalva: a case report and review of the literature. Journal of the American Society of Echocardiography, 17(2): 173-177
Fueglistaler, P., Wolff, T., Guerke, L., Stierli, P., Eugster, T. (2005) Endovascular stent graft for symptomatic mobile thrombus of the thoracic aorta. Journal of Vascular Surgery, 42(4): 781-783
Gagliardi, J., Batt, M., Khodja, R., le bas Pierre (1988) Mural Thrombus of the Aorta. Annals of Vascular Surgery, 2(3): 201-204
Hahn, T.L., Dalsing, M.C., Sawchuk, A.P., Cikrit, D.F., Lalka, S.G. (1999) Primary Aortic Mural Thrombus: Presentation and Treatment. Annals of Vascular Surgery, 13(1): 52-59
Hassan, I., Zehr, K.J., Freeman, W.K. (2001) A case of asymptomatic thoracic aorta mural thrombi. Annals of Thoracic Surgery, 72(5): 1735-1737
Hausmann, D., Gulba, D., Bargheer, K., Niedermeyer, J., Comess, K.A. (1992) Successful thrombolysis of an aortic-arch thrombus in a patient after mesenteric embolism. N Engl J Med, 327: 500-1
Hisagi, M., Morota, T., Endo, M., Taketani, T., Takamoto, S. (2007) Floating thrombus in the ascending aorta. General Thoracic and Cardiovascular Surgery, 55(1): 38-40
Ito, H., Takahashi, K., Sasaki, H., Akiho, H., Katahira, Y., Saito, H., Ishibashi, T. (2001) Large Thrombus in the Ascending Aorta Successfully Treated by Thrombolysis. Japanese Circulation Journal, 65(6): 572-574
Laperche, T., Laurian, C., Roudaut, R., Steg, P. G. (1997) Mobile Thromboses of the Aortic Arch Without Aortic Debris : A Transesophageal Echocardiographic Finding Associated With Unexplained Arterial Embolism. Circulation, 96(1): 288-294
Malyar, N.M., Janosi, R.A., Brkovic, Z., Erbel, R. (2005) Large mobile thrombus in non-atherosclerotic thoracic aorta as the source of peripheral arterial embolism. Thrombosis Journal, 3(1): 19
Nader, R.G., Barr, F., Rubin, R., Hirshfeld, J.W., Eisen, H.J., Laposata, E. (1989) Aortic degenerative changes and thrombus formation: An unusual cause of massive myocardial infarction with normal coronary arteries. American Journal of Medicine, 86(6): 718-722
Nakajima, M., Tsuchiya, K., Honda, Y., Koshiyama, H., Kobayashi, T. (2009) Acute pulmonary embolism after cerebral infarction associated with a mobile thrombus in the ascending aorta. General Thoracic and Cardiovascular Surgery, 57(12): 654-656
o`connell J.B., Quinones-Baldrich, W.J. (2009) Proper evaluation and management of acute embolic versus thrombotic limb ischaemia. Semin Vasc Surg, 22, 10e6
Onwuanyi, A., Sachdeva, R., Hamirani, K., Islam, M., Parris, R. (2001) Multiple Aortic Thrombi Associated With Protein C and S Deficiency. Mayo Clinic Proceedings, 76(3): 319-322
Pousios, D., Velissaris, T., Duggan, S., Tsang, G. (2009) Floating intra-aortic thrombus presenting as distal arterial embolism. Interactive CardioVascular and Thoracic Surgery, 9(3): 532-534
Rancic, Z., Pfammatter, T., Lachat, M., Frauenfelder, T., Veith, F.J., Mayer, D. (2009) Floating aortic arch thrombus involving the supraaortic trunks: Successful treatment with supra-aortic debranching and antegrade endograft implantation. Journal of Vascular Surgery, 50(5): 1177-1180
Sawada, T., Shimokawa, T. (2011) Giant thrombus in the ascending aorta that caused systemic embolism. Interactive CardioVascular and Thoracic Surgery, 12(6): 1048-1050
Turley, R.S., Unger, J., Cox, M.W., Lawson, J., McCann, R.L., Shortell, C.K. (2014) Atypical Aortic Thrombus: Should Nonoperative Management Be First Line?. Annals of Vascular Surgery, 28(7): 1610-1617