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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2002 June;21(2):123-7


language: English

The proximal form of mural thrombus in aortoiliac occlusive disease using computed tomography

Jibiki M., Inoue Y., Kurihara N., Tamai S., Kubota T., Hirokawa M., Sugano N., Nakashima E., Iwai T.

Division of Vascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Graduate School of Medicine, Yushima, Bunkyoku, Tokyo, Japan


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.

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