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      Saddle embolism treated by thrombolysis and thrombus aspiration via bilateral femoral artery puncture catheter : A case report

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          Abstract

          Introduction:

          Abdominal aortic saddle embolism is a rare and severe disease with the manifestation of abrupt onset, rapid progression and high mortality. Endovascular therapy becomes a new option for this disease due to its minor trauma, less complications, no requirement for general anesthesia or abdominal incisions, and shorter hospitalization duration.

          Methods:

          A 50-year-old female was diagnosed as abdominal aortic saddle embolism, and thrombus aspiration was given immediately via bilateral femoral artery puncture catheter along with artery indwelling catheter thrombolysis.

          Results:

          The saddle embolism was removed completely. After 1-month follow-up, the computed tomography angiography (CTA) examination showed neither stenosis nor thrombus in the abdominal aorta and iliac artery. The patient achieved perfect outcome.

          Conclusions:

          Endovascular therapy may be an optional solution for saddle embolism.

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          Most cited references5

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          Management of acute aortic thrombosis.

          Mark Kaschwich, Christian A. Behrendt, Nikolaos Tsilimparis … (2017)
          Acute aortic thrombosis (AAT) is a rare life threatening event that leads to a sudden occlusion of the aorta. The mortality and morbidity of AAT is still high despite modern surgical techniques. Usually it is the result of a large saddle embolus to the aortic bifurcation, in situ thrombosis of an atherosclerotic aorta or acute occlusion of an abdominal aortic aneurysm. Clinical symptoms depend on the level of the aortic occlusion and can be mistaken for a stroke or similar neurological disease. The combination of age and advanced cardiac disease seems to be significant risks factors for AAT. In patients who have no cardiac or vascular disease this catastrophic event is very rare and is mostly due to hypercoagulable disorders. Revascularization of the ischemic organ/limb as soon as possible is the major aim in the therapy of AAT to avoid further ischemic damage. Surgical reperfusion is the first line approach. If the accepting clinic has no facilities for an immediate surgical intervention it is of primary importance that these patients should be referred to an appropriate center for further management. Paradox seems the fact that most of the patients die as a consequence of reperfusion injury/postperfusion syndrome that occurs after revascularization of acute ischemic limbs.
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            Aortic replacement in aorto-occlusive disease: an observational study

            Gareth Morris-Stiff, Samuel Ogunbiyi, Richard Winter … (2008)
            Background For many patients with aorto-occlusive disease, where stent deployment is not possible, surgery remains the only treatment option available. The aim of this study was to assess the results of aortic reconstruction surgery performed in patients with critical ischaemia. Methods All patients with critical ischaemia undergoing surgery during 1991–2004 were identified from a prospectively maintained database. Mortality data was verified against death certificate data. Demographic and clinical data were obtained from the clinical notes and the radiology database. Disease was classified as: type I – limited to aorta and common iliac arteries; type II – external iliac disease and type III combined aortic, iliac and infra-inguinal disease. Results 86 patients underwent aortic replacement surgery all of whom had critical ischaemia consisting of: type I (n = 16); type II (n = 37) and type III (n = 33). The 30-day mortality rate was 10.4%, the one-year patient survival was 80%, and the 1-year graft survival was 80%. At 2 years the actual patient survival was 73% and no additional graft losses were identified. All patients surviving 30 days reported excellent symptomatic relief. Early, complications occurred in 6 (7%) patients: thrombosis within diseased superficial femoral arteries (n = 4); haemorrhage and subsequent death (n = 2). Ten (14%) late complications (> 12 months) occurred in the 69 surviving patients and included: anastomotic stenosis (n = 3); graft thrombosis (n = 4), graft infection (n = 3). Four patients developed claudication as a result of more distal disease in the presence of a patent graft, and 1 patient who continued smoking required an amputation for progressive distal disease. Conclusion Aortic reconstruction for patients with extensive aorto-occlussive disease provides long-standing symptomatic relief for the majority of patients. After the first year, there is continued patient attrition due to co-existent cardiovascular disease but no further graft losses.
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              Aortic thrombus in a patient with myeloproliferative thrombocytosis, successfully treated by pharmaceutical therapy: a case report

              Hidesuke Yamamoto, Haruaki Nishimaki, Norikazu Tsunekawa-Imai … (2010)
              Introduction Thrombosis in myeloproliferative thrombocytosis occurs usually in the microvessels and medium-sized arteries and veins and only rarely in the aorta. Aortic thrombosis is usually treated with thrombectomy. Reported here is a rare case that was treated pharmacologically. Case presentation A 60-year-old Japanese woman presented with numbness of both lower extremities. Her platelet count was 1787 × 103/μl. Through bone marrow examination, we diagnosed her condition as myelodysplastic and/or myeloproliferative disorder-unclassifiable. Abdominal ultrasonography and computed tomographic scan revealed aortic thrombosis. Her platelet count was controlled with hydroxyurea and ranimustine. Aspirin and ticlopidine improved the numbness in both lower limbs on the second day. Aortic thrombosis was not observed in a computed tomographic scan on the seventh day. Conclusion For aortic thrombosis, surgical management is usually adopted, but pharmacological management is also an option because of its immediate curative effects.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: March 2018
                Publication date (Electronic): 30 March 2018
                Volume: 97
                Issue: 13
                Electronic Location Identifier: e0212
                Affiliations
                Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
                Author notes
                [∗ ]Correspondence: Guangqiang Zhang, Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (e-mail: zhgqzju@ 123456126.com ).
                Article
                Publisher ID: MD-D-17-08260 Accession ID: 00212
                DOI: 10.1097/MD.0000000000010212
                PMC ID: 5895400
                PubMed ID: 29595665
                SO-VID: ed09002f-ba7a-4444-920d-42d37a748b64
                Copyright © Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                History
                Date received : 4 January 2018
                Date revision received : 28 February 2018
                Date accepted : 1 March 2018
                Categories
                Subject: 6800
                Subject: Research Article
                Subject: Clinical Case Report
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: abdominal aortic saddle embolism,aorto-occlusive disease,indwelling catheter thrombolysis,thrombus aspiration
                Data availability:
                Keywords: abdominal aortic saddle embolism, aorto-occlusive disease, indwelling catheter thrombolysis, thrombus aspiration

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