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Mural aortic thrombi: An important cause of peripheral embolization
P U Reber1, A G Patel, E Stauffer
1Division of Vascular Surgery, Inselspital, University of Bern, Switzerland.
Journal of Vascular Surgery
|December 10, 1999
Summary
Mural aortic thrombi (MAT) are an underrecognized cause of arterial thromboembolism. Imaging like CT or MRI is crucial for diagnosis, and surgical removal of MAT offers successful treatment with low morbidity.
Area of Science:
- Vascular Surgery
- Cardiology
- Diagnostic Imaging
Background:
- Arterial thromboembolism from unknown sources leads to significant morbidity and mortality.
- Advances in imaging, including transesophageal echocardiography (TEE), magnetic resonance imaging (MRI), and computed tomography (CT), have increased the identification of mural aortic thrombi (MAT) as an embolic source.
- MAT were previously underappreciated as a cause of distal embolization.
Purpose of the Study:
- To report the incidence, diagnosis, and treatment of patients with mural aortic thrombi (MAT).
- To highlight MAT as a significant source of arterial thromboembolism.
- To evaluate the diagnostic and therapeutic approaches for MAT.
Main Methods:
- A prospective study included 89 patients with acute embolic events from January 1996 to December 1998.
- Patients underwent extensive diagnostic workup, including TEE, CT, or MRI, to identify the source of embolization.
- Patients with cardiac sources, aortoiliac disease, or aortic aneurysms were excluded, identifying 8 patients with MAT.
Main Results:
- Mural aortic thrombi (MAT) were identified in 9% of patients with arterial thromboembolism, with a median age of 63 years.
- Percutaneous catheter aspiration embolectomy was successful in six patients; two underwent surgical thromboembolectomy, with 25% requiring below-knee amputation.
- MAT were detected in the ascending, thoracic, and abdominal aorta using TEE, CT, or MRI. Surgical removal in seven patients resulted in no intraoperative or postoperative complications, with no recurrence during follow-up.
Conclusions:
- Mural aortic thrombi (MAT) are an important and often overlooked source of arterial thromboembolism.
- Aortic imaging (CT or MRI) is recommended for patients with unexplained embolic events after other sources are ruled out.
- Surgical treatment of MAT can be effective with low mortality and morbidity, though further prospective evaluation is needed.