Aortic Thrombosis Research Articles

Acute Aortoiliac Thrombosis Due to Cocaine Intake

Cocaine has become one of the most commonly abused recreational drugs, resulting in a significantly increased number of visits to the emergency department due to the acute symptoms caused by its intake. The acute onset of cardiovascular complications, such as myocardial infarction, arrhythmias, stroke, and kidney and spleen infarction, has been described in association with cocaine use, but aortic thrombosis has rarely been studied in this context. We report a case of acute aortoiliac thrombosis in a young male patient with no underlying medical records.

Mechanical heart valve thrombosis and novel oral anticoagulants: a word of caution

not surprising that even vitamin K antagonists are prescribed to achieve different therapeutic levels in patients with AF versus mechanical heart valves, particularly in the mitral position. Therefore, the dosing of the new anticoagulants will likely have to be tailored to the indication for anticoagulation. There have only been a few preclinical models investigating the possible role of either dabigatran or rivaroxaban in mechanical valve thrombo-prophylaxis. McKellar and colleagues used an in vivo swine model whereby a modified bileaflet mechanical valved conduit (St Jude Masters Series, St Jude Medical, Inc., MN, USA) was implanted to bypass the ligated, native descending thoracic aorta to compare the amount of valve thrombosis at 30 days in a control group (no anticoagulation), a clinical group control (enoxaparin 2 mg/kg twice daily) and experimental group (dabigatran 20 mg/kg twice daily) [7]. Their short-term results demonstrated that dabigatran was as effective as enoxaparin in preventing modified heterotopic mechanical aortic valve thrombosis. There was no mortality difference between all groups. Conversely, Schomburg and colleagues used an orthotopic swine mechanical mitral valve replacement model (27 mm Carbomedics OptiFormTM Mitral Valve, Sorin, Vancouver, Canada), comparing control group (no anticoagulation), clinical control group (warfarin therapy) and experimental group (dabigatran therapy at 20 mg/kg twice daily) and demonstrated a significant survival benefit of the use of dabigatran when compared with warfarin therapy. However, thrombus presence at necropsy was found to be twice as high in the dabigatran group (80%) versus the warfarin group (40%; p = 0.2) [8]. Although in vitro studies demonstrated similar effectiveness of dabigatran or rivaroxaban to unfractionated heparin and low molecular weight heparin in Oral anticoagulant therapeutic options are currently expanding, not only in drug types, but their clinical indications. Dabigatran etexilate (Pradaxa) is a direct thrombin (IIa) inhibitor that has been approved for prevention of embolic stroke related to nonvalvular atrial fibrillation (AF) following results from the RE-LY trial, a study comparing dabigatran (110 or 150 mg twice daily) with warfarin in patients with nonvalvular AF, were published in 2009 [1,2]. RE-LY demonstrated similar rates of thromboembolic events in low-dose dabigatran versus warfarin, while higher doses of dabigatran showed even fewer thromboembolic events [2]. Along with other trials investigating new oral anticoagulants in patients with nonvalvular AF (RE-LY [2], ARISTOTLE [3], AVERROES [4], ROCKET-AF [5]), current national guidelines now have recommendations for the use of dabigatran, apixaban and rivaroxaban for prevention of stroke in nonvalvular AF patients and prevention of deep vein thrombosis following orthopedic surgery [1,6]; however, there is little information regarding the use of these medications in mechanical valve thromboprophylaxis. Thus, off-label use of these new drugs could lead to catastrophic complications, since their mechanism of anticoagulation does not mirror that of vitamin K antagonists.

Native aortic valve thrombosis: an unusual cause of acute ST-elevation myocardial infarction

Coronary artery embolism is an infrequent cause of acute myocardial infarction. In addition, native aortic valve thrombosis is a very rare condition. We report a case of native valve thrombosis causing acute ST-elevation myocardial infarction in healthy middle-aged man who has no established cardiovascular risk factor. We diagnosed native aortic valve thrombosis using various imaging techniques and confirmed our diagnosis histopathologically after surgical operation.

Neonatal aortic arch thrombosis: analysis of thrombophilic risk factors and prognosis

Arterial thrombosis in neonates and children is a rare event and is often associated with external risk factors such as asphyxia or sepsis. We report our experiences with two neonates with spontaneous aortic arch thrombosis mimicking aortic coarctation. Despite single case reports until now, no data exist for the underlying thrombophilic risk factors and prognosis of this rare event. Both patients were carriers of a heterozygous factor V Leiden mutation, which has been reported once before as a risk factor for aortic arch thrombosis. One of our patients was operated upon successfully and is alive. The second patient suffered a large infarction of the right medial cerebral artery and had a thrombotic occlusion of the inferior caval vein. The patient obtained palliative care and died at the age of 6 days. In the literature, we identified 19 patients with neonatal aortic arch thrombosis. Of the 19 patients, 11 (58%) died. Including the two reported patients, the mortality rate of patients with multiple thromboses was 80% (8/10) compared with 18% (2/11) for patients with isolated aortic arch thrombosis; this difference reached statistical significance (p = 0.009). The analysis of thrombophilic disorders revealed that factor V Leiden mutation and protein C deficiency seem to be the most common risk factors for aortic arch thrombosis. Neonatal aortic arch thrombosis is a very rare but life-threatening event, with a high rate of mortality, especially if additional thrombotic complications are present. Factor V Leiden mutation seems to be one important risk factor in the pathogenesis of this fatal disease.

Ventricular Diverticulum: A Review of the Literature

Ventricular diverticulum (VD) is a rare cardiac malformation. The surgical indications for VD remain controversial. This review is designed to determine the demographic characteristics, diagnosis, and surgical indications of this disease. Using PubMed and the Chinese electronic databases CNKI, WANFANG, and VIP, a computerized search was performed of the literature from China published between March 1965 and July 2012. Major risk factors for developing VD complications were confirmed by logistic regression analysis in case-control studies. Ninety-three articles and 127 VD patients were identified in this literature review. VDs can lead to aortic insufficiency, thrombosis, infective endocarditis, heart failure, diverticular rupture, ventricular arrhythmia, and cerebral embolism. In patients with VD complications, 92.3% were men (OR = 6.43, 95% CI = 1.23-33.53), 84.6% of the patients had a fibrous type VD (OR = 10.54, 95% CI = 2.86-38.85), and 48.0% of the cases were subaortic diverticulum (SD) related (OR = 6.41, 95% CI = 1.17-35.19). VD can result in rupture, cerebral embolism, heart failure, ventricular arrhythmia, infective endocarditis, thrombosis and aortic insufficiency. Male gender, fibrous type, and SD are three major independent risk factors for developing VD complications. Surgical resection should be performed in those VD patients with risk factors for major complications.

Acute Aortic Thrombosis during Cisplatin Based Chemotherapy for Gastric Cancer

The development of aortic thrombosis without the presence of atheroscrelosis, dissection, or aneurysms is rare. A cancer-related hypercoagulable state is a well-known risk factor for venous thrombosis, however, atrial thrombosis has rarely been reported in cancer patients. Cisplatin-based chemotherapy is known to cause various side-effects. Detecting aortic thrombosis is important because it is a fatal condition. We herein present the first reported case of endo-aortic thrombosis occurring during cisplatin-based chemotherapy for gastric cancer.

Aortic Dissection and Thrombosis Diagnosed by Emergency Ultrasound in a Patient with Leg Pain and Paralysis

The authors present a case of aortic dissection and abdominal aortic aneurysm thrombosis in a 78-year-old male who presented to the emergency department (ED) complaining of lower extremity and paralysis for the past 1.5 hours. The initial vital signs in the ED were as follows: blood pressure (BP) 132/88 mmHg, heart rate (HR) 96, respiratory rate (RR) 14, and an oxygen saturation of 94% at room air. Physical exam was notable for pale and cold left leg. The ED physician was unable to palpate or detect a Doppler signal in the left femoral artery. Bedside ultrasound was performed which showed non-pulsatile left femoral artery and limited flow on color Doppler. Abdominal aortic aneurysm screening ultrasound was performed showing a 4.99 cm infrarenal abdominal aortic aneurysm and an intra-aortic thrombus with an intimal flap. Vascular surgery was promptly contacted and the patient underwent emergent aorto-bi-femoral bypass, bilateral four compartment fasciotomy, right common femoral artery endarterectomy with profundoplasty, and subsequent left leg amputation. Emergency physicians should utilize bedside ultrasound in patients who present with risk factors or threatening signs and symptoms that may suggest aortic dissection or aneurysm. Bedside ultrasound decreases time to definitive treatment and the mortality of the patients.

ANO Detection with K-Nearest Neighbor Using Minkowski Distance

Full unloading of the left ventricle in patients implanted with ventricular assist devices over a long period of time has been reported to cause aortic valve fusion and thrombosis. Therefore, it is vital to detect the occurrence of aortic valve non-opening (ANO) in these patients. In the present study, measurements were obtained from four greyhounds under a wide range of operating conditions, which covered varying levels of blood volume, vascular resistances, contractilities and pumping speeds. K nearest neighbor classifier was implemented on two features, i.e. root mean square and standard deviation of pump speed amplitude. Classification performance using different Minkowski distance metrics (Manhattan distance, Euclidean distance, Minkowski distance with a power of 3 and Chebyshev distance) and k parameter (odd numbers ranging from 1 to 29) were evaluated. Results showed that the compared metrics achieved similar performance (accuracy of 93%) and concurred unanimously with regards to the optimal numbers of k parameters (k=9) for the data tested. 

A Septic Thrombus Cause of An Acute Massive Aortic-iliac and Mesenteric Occlusion

Acute aortic occlusion is a rare and catastrophic pathology with high mortality even after revascularization. Literature describes cases of acute aortic-iliac thrombosis due to cardiac emboli arising from left ventricle, but, so far, only few cases have been described about acute aortic iliac thrombosis due to a floating thrombus in descending aorta. In best of our knowledge the case we report is the first one of aortic iliac and superior mesenteric artery occlusion due to a single septic thrombus arising from descending aorta.

Aortic arch thrombosis mimicking interrupted aortic arch.

We report a case of a 32-week-gestation male who presented initially with symptoms suggestive of an interrupted aortic arch. The absence of a VSD prompted further investigations, including a CT angiogram, which revealed that he had an extensive thrombus in his aorta. He underwent a successful aortic thrombectomy with arch repair on cardiopulmonary bypass support. In view of the extensive thrombus, the patient was referred to the haematology team. There was no family history of prothrombotic tendencies.

A case of massive aortic thrombosis with catastrophic cerebrovascular embolization and infarction

Introduction: Antiphospholipid syndrome (APS) is the most common type of acquired thrombophilia. Lupus anticoagulant (LA) is more commonly associated with venous than with arterial thrombosis and accounts for 6–8% of thrombotic events. Case Report: A 50­year­ old African­American male presented to the emergency department with right sided hemiparesis, facial droop and impaired speech. First symptoms were noted about 10–12 hours before presentation to the emergency department. During two weeks preceding admission, patient experienced several transient episodes of similar neurological deficits. Computed tomography (CT) scan of brain done on admission showed ischemic stroke involving the area of distribution of the left middle cerebral artery. The CT angiography of brain revealed a large thrombus in the aortic arch, left common carotid and internal carotid artery. Laboratory studies were positive for lupus anticoagulant. Serial brain CT scan demonstrated increasing brain edema and midline shift eventually leading to transtentorial herniation. Several days after admission, neurological examination revealed loss of brain stem reflexes. Conclusion: Antiphosphotipid syndrome (APS) is the most common type of acquired thrombophilia. Lupus anticoagulant is mainly associated with venous thrombosis and accounts for 6–8% of thrombotic events in otherwise healthy patients. Prompt diagnosis and treatment, with long­term anticoagulation for survivors is crucial. The most common site of arterial thrombosis in APS is central nervous system, presenting with stroke and transient ischemic attacks in 50% of the cases. Patients with diagnosed APS and prior thrombosis have high risk for recurrent events. Due to this fact some authors postulate lifelong anticoagulation therapy.

Endovascular Treatment of Acute Abdominal Aortic Thrombosis after Cisplatin-Based Chemotherapy

A 75-year-old male received preoperative cisplatin-based adjuvant chemotherapy for advanced gastric cancer. Three days after administration of cysplatin, the patient presented severe abdominal pain and calf claudication. A multi detector computed tomography (MDCT) revealed a floating mass in the infrarenal abdominal aorta. Considering the underlying malignant disease and subsequent laparotomy, we adopted endovascular treatment as a less invasive treatment: Fogarty thrombectomy followed by stent graft exclusion. Although cisplatin-based chemotherapy is known to be a high risk thromboembolic event, acute thrombosis of the aorta is exceedingly rare and its standard therapeutic management is not well established. We believe this procedure will prove to be a reliable less invasive treatment for this entity in cases of high-risk, such as with cancer patients.

Multiple Aortic Thrombosis Successfully Treated Using Pharmacotherapy

Multiple Aortic Thrombosis Successfully Treated Using Pharmacotherapy

Computational Fluid Dynamic Analysis to Prevent Aortic Root and Valve Clots during Left Ventricular Assist Device Support

Aortic root and valve clots are rare but well described in patients on maximal left ventricular assist device (LVAD) support. We performed a theoretical analysis using computational fluid dynamic analyses in two dimensions to try and ascertain if inflow cannula design/orientation/placement affect aortic root flow dynamics. Two-dimensional computational fluid dynamics using easy CFD-G was performed. The effect of a curved inflow cannula, a straight cannula, and one with a hole in the outer curve was analyzed. In addition, the effect of inflow conduit angulation on the ascending aorta was studied. Computational fluid dynamic (CFD) analysis predicts that stagnant blood exists in the aortic root when little or no cardiac ejection is taking place. Coronary flow is too small to affect the root flow streamlines. A hole on the root side of a curved inflow aortic cannula increases the flow in the aortic root and may decrease the incidence of root and valve thrombosis. The angle of the inflow conduit attachment to the ascending aorta was also found to be crucial with regard to aortic root blood stasis. In addition, a baffle at the tip of the inflow cannula may prove to be beneficial. Theoretical analysis using the technique of CFD predicts that inflow cannula position and design may affect the incidence of aortic root thrombosis during LVAD support when minimal cardiac ejection is occurring.

Aortic root thrombosis after transhiatal esophagectomy: A case report

Aortic root thrombosis after transhiatal esophagectomy: A case report

Neonatal ascending aortic thrombus: successful medical treatment

Neonatal aortic thrombosis is a potentially life-threatening condition with significant morbidity and mortality if undiagnosed and untreated. The most common location of arterial thrombosis in neonates is in the abdominal aorta and is associated with umbilical artery catheterisation. There are only a few previous reports of thrombosis in the ascending aorta. We describe a case of ascending aortic thrombosis in a neonate who underwent successful thrombolytic therapy.

Aortic thrombosis in dogs: 31 cases (2000–2010)

To describe clinical signs, treatment, and outcome of aortic thrombosis in dogs. Retrospective case series. 31 dogs with aortic thrombosis. Records were retrospectively reviewed and data collected regarding signalment, historical signs, physical examination findings, laboratory testing, definitive diagnosis, and presence of concurrent disease. The records of 31 dogs with clinical or postmortem diagnosis of aortic thrombosis were reviewed. Onset of clinical signs was acute in 14 (45%) dogs, chronic in 15 (48%), and not documented in 2 (6%). Femoral pulses were subjectively weak in 6 (19%) dogs and absent in 17 (55%). Frequent laboratory abnormalities included high BUN concentration (n = 13), creatinine concentration (6), creatine kinase activity (10), and D-dimer concentration (10) and proteinuria with a urine protein-to-creatinine concentration ratio > 0.5 (12). Concurrent conditions included neoplasia (n = 6), recent administration of corticosteroids (6), and renal (8) or cardiac (6) disease. Median survival time was significantly longer for dogs with chronic onset of disease (30 days; range, 0 to 959 days) than for those with acute onset of clinical signs (1.5 days; range, 0 to 120 days). Results suggested that aortic thrombosis is a rare condition in dogs and accounted for only 0.0005% of hospital admissions during the study period. The clinical signs for dogs with aortic thrombosis differed from those seen in feline patients with aortic thromboembolism. Median survival time was significantly longer for dogs with chronic disease than for dogs with acute disease. Despite treatment, outcomes were typically poor, although protracted periods of survival were achieved in some dogs.

A Unique Case of Splenic Pseudoaneurysm Secondary to the Heimlich Maneuver

Background: The Heimlich maneuver has become the technique of choice for choking victims. While effective, complications are often overlooked. We present a unique case of splenic pseudoaneurysm formation and delayed rupture due to the Heimlich maneuver. Case: 86-year-old male with medical history of diabetes mellitus, hypertension, lung cancer, chronic obstructive pulmonary disease, end stage renal disease on hemodialysis, was found to be choking on food. The Heimlich maneuver was performed, and food particles were expelled. He was briefly intubated and hospitalized. On day 2 of admission, patient developed a sudden drop in hemoglobin from 11 g/dL to 7.4 g/dL on routine labs, subsequently down to a low of 5.6 g/dL. Vital signs were stable. Physical exam was significant for mild diffuse tenderness and distension without peritoneal signs. An abdominal CT scan without contrast revealed hemoperitoneum collecting in a right inguinal hernia and no free air. A CT angiogram of the abdomen and pelvis was then performed, revealing a subcapsular/perisplenic hematoma and adjacent splenic pseudoaneurysm in the anterior upper pole of the spleen (Figure). Selective arteriogram of the celia-comesenteric trunk confirmed a splenic pseudoaneurysm, which was successfully embolized using multiple embolization coils. The patient's hemoglobin stabilized after the embolization and transfusion of 4 units of packed red blood cells. He was started on a dysphagia diet with thickened liquids for pharyngeal dysphagia. Discussion: This is the first reported case of a splenic pseudoaneurysm secondary to the Heimlich maneuver to our knowledge in the English literature. Complications of the Heimlich maneuver including bowel and splenic rupture, aortic thrombosis and solid organ lacerations have been reported. The elderly are especially susceptible to these adverse events due to comorbidities, as well as an increased incidence of dysphagia. This case highlights a delayed complication of the Heimlich maneuver. A high index of suspicion is warranted, and all choking victims on whom the maneuver has been performed should undergo medical examination.Figure: [859] A perisplenic hematoma is seen (arrow). Adjacent high attenuation density following blood pool was consistent with a pseudoaneurysm.

Ascending aorta thrombosis in a HeartWare® left ventricular assist device recipient

Supplementary material (Video S1 and Video S2) is available at EJCTS online. Video 1: Aortic angiography and computed tomography view of the aortic thrombus. Video 2: Perioperative view of HeartWare implantation and morpho-pathological aspects of the explanted heart. Figure 1: Computed tomography (CT) image of the aortic thrombus. One month after the left ventricular assist device implantation, the patient underwent in situ right middle cerebral artery fibrinolysis for embolic stroke. Cardiac echography showed the absence of any intracardiac thrombus. Five days later, multiples episodes of ventricular fibrillation occurred. Aortic angiography and echocardiography showed a complete thrombosis of the left Valsalva sinus, which was resistant to medical treatment. CT examination confirmed the presence of the thrombus. Figure 2: Morphopathological view of the thrombus on the explanted heart after transplantation (showing a left main coronary trunk thrombosis). The patient was transplanted emergently, but died a few days later from multiorgan failure.

Ascending Aortic Graft Thrombosis and Diffuse Embolization From Early Endoluminal Aspergillus Infection

We present a 43-year-old man who underwent emergent replacement of the ascending aorta for type A dissection and hemiarch reconstruction with a 28-mm prosthetic graft. Dramatic neurologic symptoms, renal failure, and bowel ischemia developed on postoperative day 5. A computed tomography scan showed a large floating thrombus in the ascending aortic graft and massive peripheral embolization throughout the body.