Chronic Thrombosed Abdominal Aortic Aneurysms: A Report on Three Consecutive Cases and Literature Review

Incidental Discovery of a Chronically Thrombosed Abdominal Aortic Aneurysm: Case Report and Literature Review

“…6e8 In contrast, chronic occlusion of an AAA usually presents with progressive intermittent lower extremity claudication. 1,2,10 The woman in our case, however, presented with an incidental finding of a thrombosed AAA on abdominal CT. In the setting of a 50-year history of 2 packs-per-day smoking, the chronic nature of her underlying coexisting iliac occlusive disease allowed adequate collaterals to develop, preventing the development of lower extremity ischemic symptoms when her AAA completely thrombosed.…”

“…13 Options for open surgical repair include aneurysm resection with in-line aortic graft replacement (either straight graft or bifurcated to the iliac or femoral arteries) or extra-anatomic bypass for patients with severe cardiac, respiratory, or renal comorbidities. 1,5,9 Aorta-based inflow procedures have been shown to be superior to axillobifemoral bypass (2-year patency rates of 92% vs. 44%, respectively). 14 There are no indications from the literature for elective repair of asymptomatic chronically thrombosed AAAs.…”

“…Cases of rupture of nonsurgically spontaneously thrombosed aneurysms have also been reported. 1 The effects of thrombus on tangential wall stress are unclear. Schurink et al 22 in 2000 used a 19-ga needle to measure intrathrombotic pressure just inside the aneurysm wall and found that intrathrombotic pressures correlated well with systemic pressure, thus showing that thrombus did not reduce the mean or pulse pressure on the aneurysm wall.…”

“…1,2 We present the case of a patient with an asymptomatic and stable chronically thrombosed AAA. Few therapeutic recommendations from the literature are available for these patients despite the fact that they are at risk for aneurysm complications.…”

血栓閉塞型の腹部大動脈瘤に合併した急性下肢動脈閉塞症の1例(A case of acute limb ischemia associated with thromboembolic abdominal aortic aneurysm)

“…血栓閉塞型AAAはAAA症例の0.6～2.8% 1), 2)であると報告され，文献では51例の報告がある 1), 2), 3), 4), 8)。平均年齢は64.7±7.9歳，高血圧，糖尿病，慢性閉塞性肺疾患，末梢血管性疾患の既往症が多い。無症状で経過することもあるが，下肢や脊髄の虚血を発症すると死亡率は50%に上る。AAA内の壁在血栓が脱落してCIAの塞栓症を発症した場合は，下腹部全体の急性虚血により重篤な病態となる。一方，CIAやFAの血栓症の場合は，慢性の低灌流状態により側副血行路が発達し，下肢の虚血症状も比較的緩徐に進行することが多い 1), 2), 4), 5), 6)。本症例は，病理組織で粥状硬化性の血栓閉塞型AAAの状態が判明したことと術中所見から，右側は瘤内の壁在血栓が脱落してCIAの急性塞栓症を発症したと判断した。一方，左側はCIAの慢性動脈閉塞に血圧の低下が加わり一時的な下肢の虚血に陥っていたと判断した。…”