Atypical aortic thrombus: should nonoperative management be first line?
BACKGROUND
Aortic thrombus in the absence of atherosclerotic plaque or aneurysm is rare, and its optimal management remains unclear. Although atypical aortic thrombus (AAT) has been historically managed operatively, successful nonoperative strategies have been recently reported. Here, we report our experience in treating patients with AAT that has evolved from a primarily operative approach to a first-line, nonoperative strategy.


METHODS
Records of patients treated for AAT between 2008 and 2011 at our institution were reviewed.


RESULTS
Ten female and three male patients with ages ranging from 27 to 69 were identified. Seven were treated operatively and 6 nonoperatively. Initial presentation was variable and included limb thromboembolic events (n = 6), visceral ischemia (n = 5), and stroke (n = 1). Associated risk factors included hypercoagulability (76%; n = 10) and hyperlipidemia (38%, n = 5). In the nonoperative group, complete thrombus resolution was obtained via anticoagulation (n = 5) or systemic thrombolysis (n = 1). Complete thrombus extraction was achieved in all operative patients. There were 11 significant complications in 5 of the 7 patients (71%) in the operative group, including intraoperative lower extremity embolism, pericardial effusion, stroke, and 1 death. There was 1 complication in the patients treated nonoperatively. The median hospital length of stay was 9 days (range 3-49) for those treated nonoperatively and 30 days (range 4-115) for those undergoing operative thrombectomy.


CONCLUSIONS
Although AAT has traditionally been treated operatively, nonoperative management of AAT with anticoagulation or thrombolysis is feasible in selected patients and may lessen morbidity and length of hospitalization in those patients for whom it is appropriate.
Division of Vascular Surgery, Duke University, Durham, NC. Electronic address: ryan.turley@duke.edu.
Ryan S
RS
Turley
Division of Vascular Surgery, Duke University, Durham, NC.
Joshua
J
Unger
Division of Vascular Surgery, Duke University, Durham, NC.
Mitchell W
MW
Cox
Division of Vascular Surgery, Duke University, Durham, NC.
Jeffrey
J
Lawson
Division of Vascular Surgery, Duke University, Durham, NC.
Richard L
RL
McCann
Division of Vascular Surgery, Duke University, Durham, NC.
Cynthia K
CK
Shortell
D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D012307:Risk Factors; D017131:Thrombectomy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures