63 - Freie Mitteilung
16. Mai 2019, 13:45 - 15:15, Sopra Grande, 4. OG
Conservative treatment of floating aortic or iliac thrombus after vascular surgery
S. Hofer, M. Furrer, Presenter: S. Hofer (Chur)
Surgical thrombectomy, endovascular stentgraft placement or conservative medical treatment have been proposed in thrombuses caused by arteriosclerotic ulcers, malignant disease or antiphospholipid syndrome. Data about the management of floating aortic or iliac thrombus after surgical procedures is scarce. This study aims to assess anticoagulation as a treatment option in these cases.
From January 2016 until December 2018 181 patients underwent endovascular or open aortic and iliac aneurysm repair. We included all patients with aortic or iliac thrombus detected on CT scan performed routinely one to three days after surgery. Thereafter, we started immediately with intravenous heparin, followed by peroral medication with rivaroxaban or phenprocoumon in combination with acetylsalicylic acid. The follow-up was performed by CT scan allowing to measure the size of thrombus subsequently. Imminent complications such as visceral or peripheral embolizations were screened by CT scan or duplex ultrasound.
We identified eight patients presenting with a floating thrombus in the aorta or in the stentgraft after surgery at aortic level (three patients), at the iliac level (four patients), and at both levels (one patient). The thrombus was located in the stentgraft (four patients), in the aorta above the graft (two patients) and in the iliac arteries below the implanted graft (two patients). All patients were asymptomatic. In six patients a complete resolution of the thrombus occurred after an anticoagulation time of seven days to 17 months. Two patients showed a notable reduction of thrombus after three and six months and are still under medication. We didn’t observe any embolism to visceral organs or lower limbs.
Resolution or a remarkable reduction of the thrombus by anticoagulation occured in all patients with floating aortic or iliac thrombus after endovascular or surgical procedures. The conservative treatment strategy seems to be a safe approach for these patients.