title: Anticoagulation Alone for Aortic Segment Treatment in Symptomatic Primary Aortic Mural Thrombus Patients.
abstract: BACKGROUND
  Primary aortic mural thrombus (AMT) is a rare entity. Asymptomatic AMT may be found in imaging studies for other disease studies. Symptomatic AMT as embolic events may localize in the arterial branches of the aorta; limb ischemia is the most usual clinical presentation, though. However, when proximal aorta is compromised, visceral branches occlusion and ischemia may determine morbidity and mortality in these patients.
  
  
  METHODS
  We performed a retrospective study with collection of data from January 2011 to September 2016. Medical records of patients were reviewed for: demographic data, cardiovascular risk factors or any known prothrombotic predisposing condition, clinical presentation, vessel of embolism, localization of aortic thrombus, treatment of AMT and symptoms, follow-up, and computed tomography scan imaging findings.
  
  
  RESULTS
  A total of 8 patients were included in the study. Mean age was 54.7 ± 11.5 years, with male/female ratio 3:1. Four (50%) patients had AMT at the arch or descending aorta, 3 (37.5%) patients in the infrarenal sector, and the remaining in the visceral aorta. All but one patient received anticoagulation alone for the aortic thrombus. Patient with femoral thromboembolectomy died in the early postoperative time due to severe massive embolism. Median follow-up was 23 months (range, 1-50). Five out of seven patients showed complete aortic thrombus resolution in imaging follow up. None of the patients presented recurrence of embolic events.
  
  
  CONCLUSIONS
  An anticoagulation first-approach treatment may be reasonable if mild organ damage is encountered. This strategy may be continued if no recurrences in embolic events are encountered, as high percentage of thrombus resolution is expected. Open or endovascular may be saved for life-threatening visceral or arch branches damage.
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain. Electronic address: cauzaza@hotmail.com.
authors.forename: Andrés
authors.initials: A
authors.lastname: Reyes Valdivia
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
authors.forename: Africa
authors.initials: A
authors.lastname: Duque Santos
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Garnica Ureña
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
authors.forename: Asunción
authors.initials: A
authors.lastname: Romero Lozano
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Aracil Sanus
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Ocaña Guaita
authors.affiliation: Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gandaria
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D001027:Aortography / Q000379:methods; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D013030:Spain; D013923:Thromboembolism / Q000209:etiology; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants