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The proximal form of mural thrombus in aortoiliac occlusive disease using computed tomography
M Jibiki1, Y Inoue, N Kurihara
1Division of Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Graduate School of Medicine, Yushima, Bunkyoku, Tokyo, Japan. jibiki.srg1@tmd.ac.jp
Insights
Understanding thrombus shape in aortoiliac occlusive disease (AIOD) is crucial for juxtarenal aortic clamping. Atheromatous thrombi (wavy/circular) pose risks of microthromboembolism, necessitating careful clamping strategies.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Thrombosis Research
Background:
- Aortoiliac occlusive disease (AIOD) poses challenges for surgical interventions like juxtarenal aortic clamping.
- Accurate characterization of proximal thrombus is essential to prevent intraoperative complications.
- Enhanced computed tomography (CT) offers a non-invasive method to assess thrombus morphology.
Purpose of the Study:
- To evaluate the shape and nature of thrombi in the abdominal aorta of AIOD patients.
- To correlate CT findings with operative observations for improved diagnostic accuracy.
- To inform surgical planning for juxtarenal aortic clamping procedures.
Main Methods:
- Retrospective analysis of 22 patients undergoing aortobifemoral bypass (1999-2001).
- Examination of thrombus characteristics at four specific abdominal aorta locations using 88 CT slices.
- Correlation of CT-identified thrombus shapes with intraoperative findings.
Main Results:
- Mural thrombus identified in 31 CT slices, with four distinct shapes observed: crescent, magatama, wavy, and circular.
- Wavy and circular thrombi were predominantly atheromatous, confirmed in 40.9% of cases during surgery.
- Crescent-shaped thrombi were likely fibrin-based, while atheromatous thrombi near the renal artery raised concerns for microthromboembolism.
Conclusions:
- Wavy or circular thrombi at the juxtarenal aorta suggest an atheromatous nature.
- Temporary clamping of more proximal aorta or splanchnic arteries is recommended for patients with these thrombus types.
- This strategy aims to prevent potential kidney or bowel infarction due to microthromboembolism during surgery.
Background:
It is important to know the nature of proximal thrombus in patients with aortoiliac occlusive disease (AIOD) when juxtarenal aortic clamping is scheduled. This study was aimed to evaluate the shape and nature of thrombi at several sites of the abdominal aorta in patients with AIOD using enhanced computed tomography (CT). Final judgment was made according to the operative findings.
Methods:
Between the years 1999 and 2001, 22 patients, who underwent aortobifemoral bypass, were enrolled. The shape and nature of their thrombi were examined at 4 points (superior mesenteric, suprarenal, juxtarenal and infrarenal arteries at the level of the 2 cm before the renal artery) and 88 slices of CT were examined retrospectively.
Results:
There was mural thrombus in 31 slices, which could be classified into 4 shapes (crescent-shaped: 10 cases; magatama: 2; wavy: 12; circular: 6). The wavy and circular shaped thrombi were found to be atheromatous. Nine cases (40.9%) on operative findings were atheroma (wavy: 4; circular shaped: 5). The crescent shape might correspond to fibrin thrombus. Atheromatous thrombus clamping near the renal artery was thought to cause microthromboembolism to surrounding organs.
Conclusions:
It is recommended that the more proximal aorta or splanchnic arteries should be temporarily clamped during proximal procedures in patients with wavy or circular shaped thrombi at the juxtarenal aorta to prevent kidney or bowel infarction.