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Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
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Aortic Thrombus in a Nonaneurysmal Ascending Aorta.

Yen-Yu Chen1, Hsu-Ting Yen1, Chia-Chen Wu1

  • 1Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

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Summary

Ascending aortic thrombus (AAT) treatment outcomes show similar mortality between anticoagulation and surgery. However, open aortic surgery offers better AAT resolution and reduced embolization risk compared to anticoagulation therapy.

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Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Ascending aortic thrombus (AAT) in a nonaneurysmal aorta is rare but carries severe risks like myocardial infarction and cerebral embolization.
  • This systematic review addresses the clinical presentation and treatment outcomes for AAT.

Purpose of the Study:

  • To elucidate the clinical manifestations of ascending aortic thrombus (AAT).
  • To compare the outcomes of anticoagulation therapy versus open aortic surgery for AAT.

Main Methods:

  • A systematic review and meta-analysis of adult AAT cases from 1995-2019.
  • Data from 101 articles (107 patients) were analyzed, comparing anticoagulation therapy and open aortic surgery outcomes.
  • Primary outcome was AAT resolution; secondary outcomes included recurrent embolization, surgical complications, and mortality.

Main Results:

  • Initial anticoagulation therapy for AAT resulted in persistent thrombus in 38% and recurrent embolization in 21% of patients.
  • Open aortic surgery showed a lower risk of recurrent embolization compared to anticoagulation (P=0.002).
  • Mortality rates were similar between groups (P=0.106), but hemodynamic instability predicted mortality (P=0.008).

Conclusions:

  • Both anticoagulation and open aortic surgery for AAT yield similar mortality rates.
  • Open aortic surgery provides reliable AAT removal and reduces recurrent embolization risk.
  • Preoperative hemodynamic status is a critical factor influencing patient prognosis in AAT.