The proximal form of mural thrombus in aortoiliac occlusive disease using computed tomography.
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.
Division of Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Graduate School of Medicine, Yushima, Bunkyoku, Tokyo, Japan. jibiki.srg1@tmd.ac.jp
M
M
Jibiki
Y
Y
Inoue
N
N
Kurihara
S
S
Tamai
T
T
Kubota
M
M
Hirokawa
N
N
Sugano
E
E
Nakashima
T
T
Iwai
D000368:Aged; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007083:Iliac Artery; D008297:Male; D013927:Thrombosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed