The Experts below are selected from a list of 267 Experts worldwide ranked by ideXlab platform
R I Ruckert - One of the best experts on this subject based on the ideXlab platform.
-
thrombus in the non aneurysmal non atherosclerotic descending thoracic aorta an unusual source of Arterial Embolism
European Journal of Vascular and Endovascular Surgery, 2011Co-Authors: Nikolaos Tsilimparis, U Hanack, G Pisimisis, S Yousefi, C Wintzer, R I RuckertAbstract:Abstract Introduction Mural thrombus of the thoracic aorta is a rare clinical finding in the absence of aneurysm or atherosclerosis. Methods The medical records of all patients diagnosed with a thrombus of a non-aneurysmatic and non-atherosclerotic descending thoracic aorta (NAADTA) and treated by the senior author between 04/1997 and 04/2010 were reviewed. Results Eight patients with mural thrombus of the NAADTA were identified. Arterial Embolism was the main clinical finding in all cases and involved the lower extremities ( n = 6), mesenteric ( n = 3) or renal arteries ( n = 2). Hypercoagulable disorders were present in 3 cases and a concurrent malignancy in another 3. Two patients underwent open surgery while 4 patients were treated conservatively with anticoagulation. Of the remaining 2 patients, one was treated with a thoracic stent-graft and aorto-biiliac bypass and the other one with transfemoral thrombectomy. Technical success was achieved in all surgical cases and thrombus resolution or stable disease in the conservative management group. No thrombus recurrence was observed during a mean follow-up of 49 months. Conclusion The management of mural thrombus in NAADTA represents a challenge, especially in case of malignant disease or hypercoagulable disorder as a potential underlying pathology and should be individualized. Although no consensus exists in the literature, therapeutic anticoagulation is proposed as first-line therapy. The indication for surgical intervention results from contraindication to anticoagulation, mobile thrombus or recurrent Embolism. Whenever possible, endovascular therapy should be preferred.
Atsushi Okawa - One of the best experts on this subject based on the ideXlab platform.
-
Upper limb amputation due to a brachial Arterial Embolism associated with a superior mesenteric Arterial Embolism: a case report
BMC research notes, 2012Co-Authors: Tsuyoshi Yamada, Toshitaka Yoshii, Hideya Yoshimura, Koji Suzuki, Atsushi OkawaAbstract:Background Acute mesenteric ischemia due to an Embolism of the superior mesenteric artery is associated with a high mortality rate. Over 20 percent of acute mesenteric Embolism cases consist of multiple emboli, and the long-term prognosis depends on the incidence of subsequent embolic events at other sites. The incidence of emboli in the upper extremity associated with a superior mesenteric Arterial Embolism has rarely been described. The signs and symptoms of ischemic change in the upper limb can be masked by other circumstances, such as postoperative conditions or complications. In these cases, a late presentation or delayed diagnosis and treatment can result in limb loss.
Raimund Erbel - One of the best experts on this subject based on the ideXlab platform.
-
large mobile thrombus in non atherosclerotic thoracic aorta as the source of peripheral Arterial Embolism
Thrombosis Journal, 2005Co-Authors: Nasser Malyar, Rolf Alexander Janosi, Zoran Brkovic, Raimund ErbelAbstract:The presence of thrombi in the atherosclerotic and/or aneurysmatic aorta with peripheral Arterial Embolism is a common scenario. Thrombus formation in a morphologically normal aorta, however, is a rare event. A 50 years old woman was admitted to the mergency department for pain, coldness, and anesthesia in the the left foot. She had a 25 years history of cigarette smoking, a history of postmenopausal hormone replacement therapy (HRT), hypercholesterolemia and hyperfibrinogenemia. An extensive serologic survey for hypercoagulability, including antiphospholipid antibodies, and vasculitis disorders was negative. Transesophageal echocardiography revealed a large, pedunculated and hypermobile thrombus attached to the aortic wall 5 cm distal of the left subclavian artery. The patient was admitted to the surgery department, where a 15 cm long fresh, parietal thrombus could be removed from the aorta showing no macroscopic wall lesions or any other morphologic abnormalities. This case report demonstrates the possibility of evolving a large, pedunculated thrombus in a morphologically intact aorta in a postmenopausal woman with thrombogenic conditions such as hyperfibrinogenemia, hypercholesterolemia, smoking and HRT. For these patients, profiling the individual risk and weighing the benefits against the potential risks is warranted before prescribing HRT.
Susan Solymoss - One of the best experts on this subject based on the ideXlab platform.
-
single arm study of bridging therapy with low molecular weight heparin for patients at risk of Arterial Embolism who require temporary interruption of warfarin
Circulation, 2004Co-Authors: Michael J Kovacs, Clive Kearon, Marc A Rodger, D R Anderson, Alexander G G Turpie, Shannon M Bates, Louis Desjardins, James D Douketis, Susan R Kahn, Susan SolymossAbstract:Background—When warfarin is interrupted for surgery, low-molecular-weight heparin is often used as bridging therapy. However, this practice has never been evaluated in a large prospective study. This study was designed to assess the efficacy and safety of bridging therapy with low-molecular-weight heparin initiated out of hospital. Methods and Results—This was a prospective, multicenter, single-arm cohort study of patients at high risk of Arterial Embolism (prosthetic valves and atrial fibrillation with a major risk factor). Warfarin was held for 5 days preoperatively. Low-molecular-weight heparin was given 3 days preoperatively and at least 4 days postoperatively. Patients were followed up for 3 months for thromboEmbolism and bleeding. Eleven Canadian tertiary care academic centers participated; 224 patients were enrolled. Eight patients (3.6%; 95% CI, 1.8 to 6.9) had an episode of thromboEmbolism, of which 2 (0.9%; 95% CI, 0.2 to 3.2) were judged to be due to cardioEmbolism. Of these 8 episodes of thromboEmbolism, 6 occurred in patients who had warfarin deferred or withdrawn because of bleeding. There were 15 episodes of major bleeding (6.7%; 95% CI, 4.1 to 10.8): 8 occurred intraoperatively or early postoperatively before low-molecular-weight heparin was restarted, 5 occurred in the first postoperative week after low-molecular-weight heparin was restarted, and 2 occurred well after low-molecular-weight heparin was stopped. There were no deaths. Conclusions—Bridging therapy with subcutaneous low-molecular-weight heparin is feasible; however, the optimal approach for the management of patients who require temporary interruption of warfarin to have invasive procedures is uncertain. (Circulation. 2004;110:1658-1663.)
Nikolaos Tsilimparis - One of the best experts on this subject based on the ideXlab platform.
-
thrombus in the non aneurysmal non atherosclerotic descending thoracic aorta an unusual source of Arterial Embolism
European Journal of Vascular and Endovascular Surgery, 2011Co-Authors: Nikolaos Tsilimparis, U Hanack, G Pisimisis, S Yousefi, C Wintzer, R I RuckertAbstract:Abstract Introduction Mural thrombus of the thoracic aorta is a rare clinical finding in the absence of aneurysm or atherosclerosis. Methods The medical records of all patients diagnosed with a thrombus of a non-aneurysmatic and non-atherosclerotic descending thoracic aorta (NAADTA) and treated by the senior author between 04/1997 and 04/2010 were reviewed. Results Eight patients with mural thrombus of the NAADTA were identified. Arterial Embolism was the main clinical finding in all cases and involved the lower extremities ( n = 6), mesenteric ( n = 3) or renal arteries ( n = 2). Hypercoagulable disorders were present in 3 cases and a concurrent malignancy in another 3. Two patients underwent open surgery while 4 patients were treated conservatively with anticoagulation. Of the remaining 2 patients, one was treated with a thoracic stent-graft and aorto-biiliac bypass and the other one with transfemoral thrombectomy. Technical success was achieved in all surgical cases and thrombus resolution or stable disease in the conservative management group. No thrombus recurrence was observed during a mean follow-up of 49 months. Conclusion The management of mural thrombus in NAADTA represents a challenge, especially in case of malignant disease or hypercoagulable disorder as a potential underlying pathology and should be individualized. Although no consensus exists in the literature, therapeutic anticoagulation is proposed as first-line therapy. The indication for surgical intervention results from contraindication to anticoagulation, mobile thrombus or recurrent Embolism. Whenever possible, endovascular therapy should be preferred.