ABSTRACT
Introducción. Los embolismos originados sobre aortas aparentemente sanas son una causa extremadamenterara de isquemia de miembros inferiores (MMII). Presentamos el caso de un trombo pedunculado formado sobre unaaorta torácica descendente normal, causante de embolismos periféricos que provocaron isquemia aguda en ambosMMII. Caso clínico. Mujer de 46 años de edad, con historia de 6 meses de evolución de dolor y frialdad en ambos MMII.Tras la exploración clínica se le realizó una angiotomografía, donde se observó una trombosis ilíaca bilateral con existenciade trombos en el sector de la aorta yuxtadiafragmática. Se decidió intervenir a la paciente de urgencia dada la isquemiaque presentaba, mediante una embolectomía de ambos MMII y con la colocación de una endoprótesis en la aortatorácica. Conclusión. Los trombos flotantes en la aorta torácica son una patología extremadamente rara. Describimosaquí un caso tratado satisfactoriamente mediante la colocación de una endoprótesis, que muestra cómo la cirugía endovascularpuede ser una aproximación mínimamente invasiva y totalmente efectiva para el tratamiento de esta patología
Introduction. Embolisms that have their origin in apparently healthy aortas are an extremely rare cause ofischaemia of the lower limbs. We report the case of a pedunculated thrombus that had formed over a normal descendingthoracic aorta, which caused peripheral embolisms that gave rise to acute ischaemia in both lower limbs. Case report. A46-year-old female with a 6-month history of pain and coldness in both lower limbs. Following the clinical examination,a tomography angiography scan was performed, which revealed the presence of bilateral iliac thrombosis with theexistence of thrombi in the region of the juxtadiaphragmatic aorta. Due to the ischaemia that was observed, the decisionwas taken to perform an emergency operation involving embolectomy in both lower limbs and with the placement of astent in the thoracic aorta. Conclusion. Thrombi floating in the thoracic aorta represent an extremely rare pathology.Here we report a case that was treated satisfactorily by placement of a stent, which shows that endovascular surgery canbe a minimally invasive and totally effective approach in the treatment of this pathology
Subject(s)
Humans , Female , Middle Aged , Aorta, Thoracic/abnormalities , Aorta, Thoracic/pathology , Aorta, Thoracic , Thrombosis/complications , Thrombosis/diagnosis , Angiography , Embolism/complications , Minimally Invasive Surgical Procedures/methods , Embolectomy/methods , Cardiopulmonary Bypass/methods , Thrombosis , Embolectomy/trends , Prostheses and Implants , Saphenous Vein/pathology , Saphenous Vein/surgery , Myocardial Revascularization/methods , Risk FactorsABSTRACT
Paraplegia is a well known complication after surgery for thoracic and thoraco-abdominal aneurysm but is very rare when the level involved is lower than the renal arteries. It is seen most often after treatment of ruptured aneurysm and very few cases are found in the literature reporting spinal cord ischemia after elective repair of an infrarenal abdominal aortic aneurysm. A new case of transient paraplegia following elective repair of an infrarenal abdominal aortic aneurysm is reported and different aspects of this complication are discussed. In our case, probably the interruption of blood flow in lumbar arteries and the duration of crossclamping were likely contributive factors and it suggest that a failure to appreciate the significance of collateral sources of spinal cord blood flow may be responsible for at least some cases of postoperative paraplegia.
