Single-center experience in diagnosis and treatment of primary aortic thrombosis
Objective To explore the diagnosis,treatment and prognosis of primary aortic thrombosis(PAT).Methods Clinical data from 21 patients with PAT treated in the Department of Vascular Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2023 were retrospectively col-lected,including gender,age,comorbidities,preoperative and auxiliary examination data,to summarize the informa-tion on their clinical characteristics,treatment plan,and follow-up prognosis.Results The first symptom of all the 21 patients was limb or visceral ischemia,including 7 cases of type Ⅱ,2 cases of type Ⅲ,9 cases of type Ⅳ,1 case of type Ⅱ+Ⅲ,1 case of type Ⅱ+Ⅳ and 1 case of type Ⅲ+Ⅳ.All patients underwent standardized anticoagulation therapy after admission.Among them,15 patients received surgical thrombectomy or thoracic endovascular aortic repair(TEVAR)and long-term anticoagulant and antiplatelet therapy after surgery,and 6 patients underwent complete antico-agulation and antiplatelet therapy without operation.The median follow-up time was 18 months.During the follow-up period,1 patient developed symptoms of lower limb ischemia,2 patients died,and the rest of the patients did not com-plain of discomfort and did not suffer from recurrence of visceral or lower limb ischemia.Conclusions PAT should be considered for acute limb or visceral ischemia when the source of embolus cannot be determined.If PAT is found,anticoagulation therapy should be applied throughout the course unless there are contraindications to anticoagulation.Continuous pumping of ordinary heparin may have a better effect than low-molecular-weight heparin.TEVAR is signifi-cant for the prevention of recurrent embolization,and the postoperative periodical review should be strict,and dynamic observation of PAT lesions should be carried out,so as to avoid reembolism events.
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