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Primary Aortic Mural Thrombus: Early Aggressive Aortic Intervention Leads to a Better Clinical Outcome: A Systematic
Mingyu Liu1, Xinyi Wu2, Yinde Huang1
1Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, Shenyang, China.
Insights
Aggressive intervention for primary aortic mural thrombus (PAMT) alongside anticoagulation reduces recurrence and complications. Early aortic management is key for better outcomes in PAMT patients.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Thrombosis Management
Background:
- Primary aortic mural thrombus (PAMT) management is debated, with anticoagulation as standard conservative care.
- The necessity of aggressive intervention for the primary aortic lesion remains controversial.
Purpose of the Study:
- To compare outcomes of conservative management versus aggressive aortic intervention for PAMT.
- To evaluate the efficacy of endovascular therapy versus open surgery for PAMT.
Main Methods:
- Systematic review of PubMed, Ovid, and SAGE databases (2000-2022).
- Included 99 studies with 250 patients diagnosed with PAMT.
- Categorized patients into conservative (anticoagulation only) and aggressive aortic treatment groups.
Main Results:
- The aggressive aortic treatment group had significantly lower overall complications (22.1% vs. 47.4%), aortic thrombus recurrence (5.3% vs. 35.8%), and peripheral embolism recurrence (4.4% vs. 30.7%).
- Endovascular therapy within the aggressive group showed lower complication risks (4.9%) compared to open surgery (31.9%).
- Complications in the conservative group included bleeding, thrombus recurrence, and embolism.
Conclusions:
- Early aggressive aortic management, in addition to anticoagulation, improves outcomes for PAMT.
- Endovascular therapy is a safer alternative to open surgery for aggressive PAMT management.
- Further intervention for the primary aortic lesion is recommended for reduced recurrence and complications.
Background:
Besides anticoagulation as the main conservative treatment for primary aortic mural thrombus (PAMT), whether further aggressive intervention of primary aortic lesion should be performed remains controversial.
Methods:
PubMed, Ovid, and SAGE databases were systematically searched to identify studies on the management of PAMT using anticoagulation alone or/and treatment of aorta published between 2000 and 2022.
Results:
Ninety-nine studies, total 250 patients, were included in this study. They were into 2 groups: conservative treatment group (137 patients) and aortic treatment group (113 patients). There was no significant difference in the basic characteristics between the 2 groups. In both groups, peripheral embolisms complicated by PAMT were firstly managed by medical therapy, intervention, or surgery. Then, for PAMT, conservative treatment group received only medical treatment (mainly anticoagulation) continuously, while aortic treatment group also received further aggressive intervention. Patients in the aortic treatment group showed a lower rate of overall complications (22.1% vs. 47.4%), lower recurrence rate of aortic thrombus (5.3% vs. 35.8%), and lower recurrence rate of peripheral embolism (4.4% vs. 30.7%). Complications of conservative group include various forms of bleeding, recurrence of aortic thrombus, and recurrent peripheral embolism. A small number of patients died of critical condition, and most complications were managed by endovascular treatment or surgery. Patients with aortic treatment were further divided into open surgery group (72 patients) and endovascular therapy group (41 patients), and endovascular therapy showed lower overall complications risk than open surgery (4.9% vs. 31.9%).
Conclusion:
Although anticoagulation is a basic and major conservative treatment for PAMT, a further early aggressive aortic management may lead to a lower recurrence of aortic thrombus, lower recurrence of peripheral embolic events, and less complication despite risks.
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