Thrombosis Of Abdominal Aorta Research Articles

Drug delivery under cover of erythrocytes extends drug half-life: A thrombolytic targeting therapy utilizing microenvironment-responsive artificial polysaccharide microvesicles

The development of thrombolytic drug carriers capable of thrombus-targeting, prolonged circulation time, intelligent responsive release, and the ability to inhibit thrombotic recurrences remains a promising but significant challenge. To tackle this, an artificial polysaccharide microvesicle drug delivery system (uPA-CS/HS@RGD-ODE) was constructed. It is composed of cationic chitosan and anionic heparin assembled in a layer by layer structure, followed by surface modification using RGD peptide and 2-(N-oxide-N,N-diethylamino) ethylmethacrylate (ODE) before encapsulation of urokinase-type plasminogen activator (uPA). The effect of chitosan on the basic performances of uPA-CS/HS@RGD-ODE was estimated. The in vitro results suggest the uPA carrier, CS/HS@RGD-ODE, displayed outstanding targeting specific to activated platelets (61 %) and microenvironment-responsiveness at pH 6.5, facilitating thrombus-targeting and a controlled drug release, respectively. Most importantly, in vivo experiment suggests ODE from uPA-CS/HS@RGD-ODE substantially extends the half-life of uPA (120 min), as uPA-CS/HS@RGD-ODE can adhere onto erythrocytes and deliver uPA under cover of erythrocytes enabling a prolonged circulation time in the bloodstream. Further tail vein and abdominal aorta thrombosis models confirmed uPA-CS/HS@RGD-ODE exhibited superior targeting and thrombolysis capabilities compared to systemic administration of free uPA. To the knowledge of authors, this may be the first study to develop new drug carriers for delivery of thrombolytic drugs under the cover of erythrocytes for extended drug half-lives.

ТРОМБОЗ АОРТЫ У НОВОРОЖДЕННОГО РЕБЕНКА

Aortic thrombosis is a rare, but severe and dangerous manifestation of increased thrombosis in the neonatal period. The presented clinical case demonstrates the features of the clinical course of in-frarenal abdominal aortic thrombosis in a full-term newborn. Laboratory and instrumental data are de-scribed, as well as the methods of treatment used. Despite the therapy, a fatal outcome occurred on the 26th day of life. The described clinical case expands the understanding of the possible causes, clinic, diagnosis and choice of therapies for this condition in newborns.

High Comorbidity in Premature Infant: Abdominal Aortic Thrombosis, Wolff-Parkinson-White Syndrome, Secondary Hypothyroidism

Background. Neonatal thromboses, both venous and arterial, are a rare pathology, and experience in systemic thrombolysis is very low. Thus, the methods of adult management are currently being adapted to pediatric practice.Clinical case description. This report describes clinical case of abdominal aortic thrombosis in a premature infant with later diagnosed Wolff-ParkinsonWhite syndrome and acquired hypothyroidism developed due to antiarrhythmic therapy.Conclusion. The premature boy had high comorbidity that required many specialists’ involvement. Timely systemic thrombolytic therapy and antiarrhythmic drugs selection made it possible to save the child's life and most likely to avoid disability in the future.

S1937 Acute Pancreatitis Due to Vascular Insufficiency From Celiac Artery Stenosis

Introduction: Acute pancreatitis is a leading cause of hospitalizations in the United States. The pancreas relies on blood supply from the celiac and superior mesenteric arteries. Compromise to any part of the pancreatic circulation may lead to inflammation. Vascular insufficiencies are an uncommon cause of acute pancreatitis. We present a rare case of acute pancreatitis secondary to celiac stenosis with concomitant abdominal aortic aneurysm thrombosis. Case Description/Methods: The patient is a 79-year-old female with history of tobacco use and peripheral vascular disease that presented for one day of abdominal pain. She noted nausea with non-bloody emesis during this time. Labs revealed a leukocytosis with WBC 17.1, lactate 2.7, AST 25, ALT 16, alkaline phosphatase 53, Total bilirubin 0.8, direct bilirubin 0.1, and a lipase of 976. A CTA of the abdomen was demonstrated inflammatory fluid with pancreatic tail necrosis, peripancreatic stranding, stenosis of the celiac origin and thrombosed aortic aneurysm measuring 6.1cm with distal reconstitution. She was placed on intravenous heparin and lactated ringer infusions. After the diagnosis of her acute pancreatitis, she was found to have a normal triglyceride level and IgG4 level. An abdominal ultrasound revealed gallbladder sludge without cholelithiasis or biliary dilation. There was no history of alcohol use preceding her hospitalization. Moreover, there were no new medications or over the counter supplements reported. It was felt the patient’s pancreatitis was a result of arterial insufficiency from celiac artery stenosis. The patient was seen by vascular surgery and was treated medically. During her stay she developed worsening pleural effusion and hypoxic respiratory failure requiring oxygen. She was ultimately discharged to a skilled nursing facility when medically stable (Figure). Discussion: Isolated case reports of acute pancreatitis due to vascular insufficiencies have been reported without defined incidence or prevalence. The head of the pancreas receives blood supply from the celiac trunk and superior mesenteric artery respectively. The body and tail of the pancreas are more vulnerable to ischemia, being perfused solely by the splenic artery. After ruling out common etiologies, compromise of the celiac artery was presumed to be the cause of this patient’s disease process. Conservative treatment yielded satisfactory results in our case, however the standard of care regarding acute pancreatitis with vascular insufficiencies need additional elucidation.Figure 1.: A. Celiac artery stenosis. B. Pancreatitis with pancreatic tail necrosis and peripancreatic fluid and stranding. C. Thrombosis within distal aorta.

Point-of-care Ultrasound for the Evaluation of Acute Arterial Pathology in the Emergency Department: A Case Series.

IntroductionThe use of point-of care ultrasound (POCUS) in the evaluation of vascular emergencies including abdominal aortic aneurysm and deep vein thrombosis is well established. However, no current guidelines exist to outline the use of POCUS in the management of acute peripheral arterial pathology.Case SeriesHere, we present a case series that illustrates the utility of POCUS in the assessment of both traumatic and nontraumatic peripheral arterial disease. Direct visualization of the vasculature via B-mode, color Doppler, and pulsed-wave Doppler assisted in the diagnosis of the following: 1) an acute, post-catheterization thrombus of the proximal radial artery; 2) a complete, traumatic radial artery transection; 3) a forearm hematoma with active arterial extravasation; 4) a traumatic arteriovenous fistula; 5) an acute thrombosis of an artery bypass graft; and 6) an infected pseudoaneurysm.ConclusionThe incorporation of POCUS into patient care allowed for rapid identification of significant peripheral arterial pathology and led to changes in clinical management, expedited patient care, and circumvented potentially harmful complications.

Heat transfer and hemodynamic analysis of systolic and diastolic hypertension on abdominal aortic thrombosis

Thrombosis is a blood clot formed in the vascular system and obstructs blood flow by reducing the cross-sectional area of blood vessels, posing a great threat to human health. Computational hemodynamics is a well-known method used for numerical simulation of blood flow behaviour. Diastolic and systolic hypertension can be investigated using the FVM and SIMPLE scheme for pressure-velocity coupling. Thanks to the utilization of MRI and DICOM, there is an acceptable 3D geometric accuracy based on which the geometry was constructed. In this study, a numerical study was performed on the behavior of the non-Newtonian blood flow in the abdominal aorta with different shapes of thrombus in three thermal fluxes generated by the body (i.e., running, sleeping, and standing). So, Blood flow behavior in three thrombus shapes of circular, rectangular, and triangular was also explored. This paper reported the influence of dimensionless numbers, including pressure drop, heat transfer coefficient, temperature, and Average Wall Shear Stress (AWSS). Based on clinical data, velocities in the abdominal aorta range from 1 to 1.2 m s−1, and blood temperature is 309.55 K. The results showed that the triangular thrombus was the most effective.

Severe thrombosis of abdominal aorta with distal embolism as the only clinical manifestation of Covid-19 infection

COVID-19 infection usually presents with respiratory symptoms and fever however several unusual initial presentations of this infection were reported in literature. We report a case of arterial thrombosis as a presenting features of this disease without any other COVID-19-related symptoms. This might lead to delayed COVID-19 diagnosis and isolation of suspected patient causing epidemiologic consequences and increased risk of transmission of the virus inside the hospital in time of pandemic unless timely recognized.

Anuria as a Chief Presentation of Takayasu Arteritis, a Case Report

Takayasu vasculitis is a rare type of large vessel vasculitis that primarily affects the aorta and its main branches; signs and symptoms are usually due to systemic inflammation or ischemia of an organ or limb, depending on the group of blood vessels involved. In addition, Takayasu arteritis is associated with increased platelet and coagulation activity, leading to a hypercoagulable state and thrombus formation. We report a case of a 47-year-old male who presented with a history of complete anuria for 3 days and was found to have progressively worsening kidney function. Renal Doppler ultrasound confirmed the presence of bilateral renal artery thrombosis, while Contrast- Enhanced Computed Tomography (CECT) of the abdomen and pelvis showed extensive abdominal aortic thrombosis with radiological findings consistent with large vessel vacuities. After catheter-directed thrombolytic therapy of the renal arteries, the patient started producing urine and his kidney function significantly improved. Later, Positron Emission Tomography scan (PET) confirmed large vessel Takayasu arteritis. Echocardiography showed no intracardiac thrombus, along with an extensive work up for thrombophilia, as autoimmune and vasculitis serology came back negative. This is an extremely rare presentation of Takayasu arteritis, with an unusual recovery of acute renal failure after delayed anuria due to bilateral renal artery thrombosis.

Anuria as a Chief Presentation of Takayasu Arteritis

Takayasu vasculitis is a rare type of large vessel vasculitis that primarily affects the aorta and its main branches; signs and symptoms are usually due to systemic inflammation or ischemia of an organ or a limb, depending on the group of blood vessels involved. In addition, Takayasu arteritis is associated with increased platelet and coagulation activity, leading to a hypercoagulable state and thrombus formation. We report a case of a 47-year-old male who presented with a history of complete anuria for 3 days and was found to have progressively worsening kidney function. Renal Doppler ultrasound confirmed the presence of bilateral renal artery thrombosis, while contrast-enhanced computed tomography (CECT) of the abdomen and pelvis showed extensive abdominal aortic thrombosis with radiological findings consistent with large vessel vacuities. After catheter-directed thrombolytic therapy of the renal arteries, the patient started producing urine and his kidney function significantly improved. Later, positron emission tomography scan (PET) confirmed large vessel Takayasu arteritis. Echocardiography showed no intracardiac thrombus, along with an extensive work-up for thrombophilia, as autoimmune and vasculitis serology came back negative. This is an extremely rare presentation of Takayasu arteritis, with an unusual recovery of acute renal failure after prolonged anuria due to bilateral renal artery thrombosis.

187: Abdominal Aortic Thrombosis as Initial Presentation of COVID-19 Pneumonia

Copyright © 2020 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Thrombotic complications of COVID-19.

IntroductionThe novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality. The impact of thrombotic complications has been increasingly recognized as an important component of this disease.ObjectiveThis narrative review summarizes the thrombotic complications associated with COVID-19 with an emphasis on information for Emergency Medicine clinicians.DiscussionThrombotic complications from COVID-19 are believed to be due to a hyperinflammatory response caused by the virus. Several complications have been described in the literature. These include acute limb ischemia, abdominal and thoracic aortic thrombosis, mesenteric ischemia, myocardial infarction, venous thromboembolism, acute cerebrovascular accident, and disseminated intravascular coagulation.ConclusionIt is important for Emergency Medicine clinicians to be aware of the thrombotic complications of COVID-19. Knowledge of these components are essential to rapidly recognize and treat to reduce morbidity and mortality in these patients.

Abdominal aortic thrombosis as initial presentation of COVID-19 infection: A case report

Abdominal aortic thrombosis as initial presentation of COVID-19 infection: A case report

Twelve-Month Computed Tomography Follow-Up after Thoracic Endovascular Repair for Acute Complicated Aortic Dissection

To explore the impact of thoracic endovascular aortic repair (TEVAR) on aortic remodeling (AR) and the relationship between AR and complications after TEVAR. A total of 56 patients (2 type IIIA aortic dissection [AD] and 54 type IIIB AD) with complicated acute type B aortic dissection suitable for TEVAR were prospectively enrolled. There were 44 men (78%) and 12 women (22%) with an average age of 54±13.8years. Aortic enhanced computed tomography (CT) was performed pre-TEVAR and 3, 6, and 12months postoperatively. The morphological changes in AR, namely aortic volume and false lumen thrombosis, were obtained by analyzing the CT data. The effect of TEVAR on AR was determined by the morphological changes in the aorta. The relationship between AR index, false lumen thrombosis, and complications was analyzed. The volume of the thoracic aortic true lumen gradually increased post-TEVAR, whereas the volume of the thoracic aortic false lumen gradually decreased. The volume of abdominal aortic total lumen and false lumen increased 6months postoperatively. The AR index increased significantly 3months postoperatively, which was negatively correlated with complications and mortality. The thoracic and abdominal aortic false lumen thrombosis developed gradually after TEVAR, and the degree of thoracic aortic false lumen thrombosis was negatively correlated with complications and mortality. TEVAR promotes AR. AR index and the degree of thoracic aortic false lumen thrombosis can serve as predictors of complications and mortality.

A retrospective analysis of the treatment on abdominal aortic balloon occlusion-related thrombosis by continuous low-flow diluted heparin.

Thrombosis is one of the serious complications related to prophylactic balloon occlusion of the abdominal aorta (PBOAA). This study aims to retrospectively analyze the efficacy and safety of continuous low-flow infusion of diluted heparin saline to prevent this complication related to PBOAA and further to provide the theory and evidences for using PBOAA.A study was carried out at our hospital from March 2016 to December 2018. Women with pernicious placenta previa (PPP) were treated PBOAA to prevent massive bleeding during CS. According to whether continuous low-flow infusion of diluted heparin saline was used to prevent catheter-related thrombosis or not, they were divided into 2 groups, the test group and the control group. The incidence of thrombosis between the 2 groups was compared and the effective treatment of thrombosis was also discussed. The comparison of nonparametric values was accomplished by using Fisher exact test. Statistical significance was set at P < .05.There were 31 women with PPP who received PBOAA during CS who were included in our study. Six of 19 women in control group (31.6%) developed thrombotic complications, while none of 12 women in test group. There were statistically significant differences in the incidence of thrombosis between the 2 groups (P = .037). There was no statistically significant difference in the amount of estimated blood loss and blood transfusion during CS between the 2 groups, nor was there statistically significant difference in the hospital days after CS (P > .05). All 6 women with thrombotic complications had no positive symptoms and thrombotic sequelae. The managements of thrombus included systemic anticoagulation, catheter-directed thrombolysis, and catheter-directed anticoagulation. One of the 6 women was lost to follow-up, and the thrombus of the other 5 women were completely dissolved. No other adverse outcomes or complications related to PBOAA were observed in all women in this study.Continuous low-flow infusion of diluted heparin saline is a safe procedure when PBOAA is performed for patients with PPP. It can effectively reduce or even avoid thrombosis without increasing intraoperative blood loss during CS for PPP patients.

An Atypical Presentation of Thrombotic Microangiopathy After Lung Transplant: A Case Report

Thrombotic microangiopathy (TMA) is a pathologic condition characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ injury due to microvascular endothelial lesions and thrombosis. It occurs in a variety of diseases and, unless recognized and treated, leads to severe morbidity and mortality. We present the case of a 48-year-old woman who underwent lung transplantation, initially under tacrolimus, mycophenolate mofetil (MMF), and prednisolone. Several complications emerged in the following months, including abdominal aortic and left renal artery thrombosis and cutaneous infections, although her renal function remained normal. Six months after transplant, her renal function began to deteriorate, which was assumed to be due to elevated tacrolimus levels and doses were adjusted. Due to leukopenia, MMF was changed to everolimus. One year after, she was admitted with fatigue, anemia, and renal dysfunction. Complementary exams revealed only iron deficiency, leukopenia, normal platelets, and elevated lactate dehydrogenase; her renal ultrasound was normal. A renal biopsy was performed and thrombotic microangiopathy was subsequently identified as the main cause of the renal dysfunction. Tacrolimus was therefore discontinued and MMF restarted with slow improvement of renal function. Only when everolimus was stopped did the patient's renal function show incremental improvement. TMA may be a serious complication after lung transplantation and the risk is higher when a combination of tacrolimus and everolimus is used. Renal biopsy findings are essential to confirm the final diagnosis of TMA, allowing for a change in immunosuppression to prevent permanent and severe renal damage.

Distal Extended Endovascular Aortic Repair PETTICOAT: A Modified Technique to Improve False Lumen Remodeling in Acute Type B Aortic Dissection

Data from the literature suggest that in patients with acute, complicated type B aortic dissection (cTBAD), initial successful treatment with thoracic endovascular aneurysm repair (TEVAR) is not necessarily associated with favorable remodeling of the dissected aorta during follow-up, and long-term results indicate that TEVAR failed to completely suppress false lumen patency. Sealing of all relevant distal reentries, infrarenal and/or iliac, seems to be the key issue to induce total false lumen thrombosis in abdominal aorta as well as the iliac arteries, especially in complicated patients presenting with malperfusion or complete true lumen collapse. Of the 34 consecutive patients diagnosed with cTBAD at our hospital from January 2015 to April 2018, 30 had complicated dissections receiving endovascular treatment according to the standard Provisional ExTension To Induce COmplete ATtachment (PETTICOAT) technique and were excluded from this study, whereas 4 patients with radiologic evidence of multiple reentry tears at detached lumbar arteries and iliac bifurcation with complete true lumen collapse and clinical evidence of malperfusion were treated with a modified PETTICOAT technique with distal extension of the aortic stent, balloon expansion of the stented true lumen, and use of the AFX bifurcated endograft system to preserve the natural aortic bifurcation and provide complete distal sealing of reentry tears. Primary technical success was achieved in all patients. No postoperative deaths were observed, but 1 patient experienced an hemorrhagic shock on the second postoperative day. No patient suffered postoperative stroke, paraplegia, paraparesis, or acute renal failure. Using an abdominal aortic bifurcated endograft with PETTICOAT to treat acute cTBAD seems to be a feasible approach in high-risk patients to improve aortic remodeling. The AFX bifurcated endograft system meets the requirements of anatomical fixation and sealing of distal tears.

Umbilical artery catheterization a cause of abdominal aortic thrombosis in neonates: A case report

Introduction: Aortic thromboembolism is relatively common among patients following cardiovascular procedures and trauma. The abdominal aorta is the most common site for thrombosis, especially its distal portion. Based on the Virchow triad, thrombosis is caused by an imbalance among endothelium, blood flow, and coagulation. Inherited or acquired hypercoagulable states play a key role in thrombus formation in both the arteria and venous system. Elevated levels of C-reactive protein, homocysteine and lipoprotein (a) are more likely to be involved with arterial thrombus. Antiphospholipid antibodies are associated with both venous and arterial thromboembolic events. The advent of new radiologic modalities, with more noninvasive techniques, has allowed for early diagnostics and treatment of these entities, in neonatal population.

PP-522 - Abdominal Aortic Thrombosis in a Newborn as a Rare Result of Dehydration

PP-522 - Abdominal Aortic Thrombosis in a Newborn as a Rare Result of Dehydration

Treatment of abdominal aortic thrombosis

To improve the outcomes in patients with abdominal aortic thrombosis. 83 patients with acute lower limbs ischemia caused by abdominal aortic thrombosis were enrolled. They have been treated at the emergency vascular surgery department of Sklifosovsky Research Institute for Emergency Care for 10-year period (2006-2016). We described surgical tactics and preferable procedure depending on severity of atherosclerotic lesion, reasons of abdominal aortic thrombosis, lower extremities ischemia severity. Timely diagnosis of abdominal aortic thrombosis and surgical treatment are essential to improve the outcomes.

Thrombo-embolic events (TEE) during neoadjuvant chemotherapy for muscle invasive bladder cancer.

339 Background: Patients with muscle invasive bladder cancer receiving neo-adjuvant chemotherapy (NAC) prior to radical cystectomy or organ preservation treatment are at higher risk of thrombo-embolic events (TEE). Methods: Retrospective data were collected on patients undergoing NAC prior to radical treatment who had surveillance CT scan chest abdomen pelvis following NAC to assess for response or underwent scan following clinical presentation during NAC requiring imaging. The aim of this study was to document the incidence and characteristics of TEE during NAC prior to radical treatment. Results: Data were collected on 94 patients between January 2012 and December 2015. Median patient age was 67 (IQR: 63, 72) with 28 (30%) females. Chemotherapy received was Cisplatin and Gemcitabine in 90% of cases, Gemcitabine and Carboplatin (9%), and Cisplatin and Etoposide (1%). Performance status was 0 in 59% of cases. G3 disease was recorded in 87%, T2 or T3 in 80% and TCC in 91% of cases. 28 TEE (29.8%, 95 % CI: 20.5%, 39%) were recorded of which 22 (79%) were subclinical TEE and 6 (21%) were clinical TEE. 23 (82%) of TEE were pulmonary emboli, 2 (7%) were concurrent pulmonary emboli and deep vein thombosis, 2 (7%) were abdominal aorta thrombosis, and 1 (4%) was a deep vein thrombosis. Conclusions: Our single centre study demonstrates that the incidence of TEE during NAC prior to radical treatment for bladder cancer is high. Improved imaging techniques lead to reporting of number of sub clinical TEE of uncertain clinical significance. These findings give weight to future prospective clinical trials to investigate the role of anti-coagulation in subclinical TEE and benefit of prophylactic anti-coagulation during NAC.