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Atypical aortic thrombus: should nonoperative management be first line?
Ryan S Turley1, Joshua Unger1, Mitchell W Cox1
1Division of Vascular Surgery, Duke University, Durham, NC.
Annals of Vascular Surgery
|April 8, 2014
Summary
Atypical aortic thrombus (AAT) management is shifting. Nonoperative strategies using anticoagulation or thrombolysis are feasible and may reduce complications and hospital stays for selected patients.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Thrombotic Disorders
Background:
- Atypical aortic thrombus (AAT), rare without atherosclerosis or aneurysm, presents a management challenge.
- Historically, AAT was treated surgically, but nonoperative approaches are emerging.
- This study reports institutional experience evolving from operative to nonoperative management for AAT.
Purpose of the Study:
- To evaluate the feasibility and outcomes of nonoperative management for atypical aortic thrombus (AAT).
- To compare the efficacy and complication rates of operative versus nonoperative strategies for AAT.
- To inform optimal treatment paradigms for AAT.
Main Methods:
- Retrospective review of patients treated for AAT between 2008 and 2011.
- Analysis of patient demographics, clinical presentations, risk factors, and treatment modalities (operative vs. nonoperative).
- Comparison of treatment outcomes, including thrombus resolution, complications, and hospital length of stay.
Main Results:
- 13 patients (10 female, 3 male; age 27-69) were identified, with 7 treated operatively and 6 nonoperatively.
- Presentations included limb thromboembolism (6), visceral ischemia (5), and stroke (1).
- Nonoperative management (anticoagulation or thrombolysis) achieved complete resolution in 6 patients with only 1 complication and a median 9-day hospital stay, versus 11 complications and a median 30-day stay in the operative group.
Conclusions:
- Nonoperative management of AAT using anticoagulation or thrombolysis is a viable option for selected patients.
- This approach may significantly reduce morbidity and length of hospitalization compared to traditional operative treatment.
- A shift towards nonoperative strategies as a first-line treatment for AAT is supported by these findings.
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