PDF(Pubmed)
Abstract：
Intraluminal thrombus formation (ILT) is a recently discovered and highly clinically relevant complication after frozen elephant trunk implantation in cardiovascular surgery. In this phenomenon, a thrombus forms within the lumen of the stent graft component of the frozen elephant trunk prosthesis and puts the patient at risk for downstream embolization with visceral or lower limb ischemia. Incidence of ILT reported in the currently available studies ranges from 6% to 17% of patients after frozen elephant trunk implantation. Adverse thromboembolic events include acute occlusion of the celiac and superior mesenteric arteries, both renal arteries as well as acute lower limb ischemia due to iliac or femoral artery embolization that not infrequently require interventional or open embolectomy. Therefore, the presence of ILT is associated with increased short-term mortality and morbidity. Currently proposed strategies to avoid ILT formation include a more aggressive anticoagulation management, minimization of postoperative coagulation factor application, and even technical optimizations of the stent graft portion itself. If ILT is manifested, the therapeutic strategies tested to date are long-term escalation of anticoagulation and early endovascular extension of the FET stent graft with overstenting of the intraluminal thrombus. The long-term efficiency of these prophylactic and therapeutic measures has yet to be proven. Nonetheless, all surgeons performing the frozen elephant trunk procedure must be aware of the risk of ILT formation to facilitate a timely diagnosis and therapy.
摘要：
腔内血栓形成（ILT）是最近发现的，在心血管手术中植入冷冻象鼻后具有高度临床相关性的并发症。在这种现象中,在冷冻的象鼻假体的支架移植物部分的管腔内形成血栓,使患者面临内脏或下肢缺血的下游栓塞风险.在目前可用的研究中报告的ILT的发生率范围为冷冻大象躯干植入后的患者的6％至17％。不良血栓栓塞事件包括急性腹腔和肠系膜上动脉闭塞，肾动脉以及因髂动脉或股动脉栓塞引起的急性下肢缺血，不经常需要介入或开放栓子切除术。因此,ILT的存在与短期死亡率和发病率增加相关.目前提出的避免ILT形成的策略包括更积极的抗凝管理，减少术后凝血因子的应用，甚至是支架移植物部分本身的技术优化。如果显示ILT,迄今为止测试的治疗策略是长期增加抗凝治疗和早期血管内扩展FET支架移植物并过度支架置入腔内血栓.这些预防和治疗措施的长期有效性尚未得到证明。尽管如此，所有进行冷冻象鼻手术的外科医生都必须意识到ILT形成的风险，以便及时诊断和治疗。
