Successful Endovascular Treatment for Aortic Thrombosis Due to Primary Antiphospholipid Syndrome: A Case Report and Literature Review

Abstract

A 60-year-old man with a history of Raynaud's phenomenon presented with bilateral intermittent claudication and an ulcer on his right toe. The ankle-brachial index of the right and left legs was 0.77 and 0.75, respectively. Laboratory data showed prolongation of the activated partial thromboplastin time and a positive result on the lupus anticoagulant test. Computed tomography angiography revealed isolated infrarenal aortic stenosis with irregular surface and noncalcified plaques. Intravascular ultrasonography examination demonstrated a noncalcified, irregular, and mobile plaque, suggestive of abdominal aortic thrombosis. In addition to anticoagulant and dual antiplatelet therapy, endovascular treatment was performed. A total of three 40-mm-long balloon-expandable stents were successfully implanted on a 15-mm balloon. The final angiography showed good results except for minimal plaque shifting in the terminal aorta. Three months later, the ulcer resolved and a final diagnosis of primary antiphospholipid syndrome (APS) was made. Clinicians should recognize that APS can affect the abdominal aorta, leading to aortic thrombosis. Endovascular treatment may be the one good treatment option for this rare condition.

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

“…Aortic thrombus is most often asymptomatic but may present with limb ischemia, visceral ischemia, or stroke 2-7 from embolization. The diagnosis is often typically confirmed by either CTA or TEE.…”

“…2-7,10,11 Long-term anticoagulation is most often considered in patients with thrombus in the ascending aorta and aortic arch, because of the increased risk of stroke from potential embolization should aortic thrombus recur. 5-7,10…”

Mobile thrombus of the abdominal aorta: a narrative review

“…Kadoya et al describe use of three 40-mm-long stents (Palmaz XL stent; Cordis, Milpitas, California) with good results after 12 months of follow-up. 32 …”

“…All cases treated with endovascular therapy had favorable outcomes. 14 , 29 - 32 It is important to emphasize that endovascular treatment has been increasingly used for thoracic aortic thrombus and appears to be an effective and safe option. 29 , 38 - 43 Studies carried out to date do not report differences between use of stent grafts and uncoated stents.…”

Thrombotic Lesions are Associated with Poor Outcomes after Endovascular Treatment in Patients with Non-Acute Aortoiliac Total Occlusions

“…C e r t a i n s y s t e m i c d i s e a s e s , s u c h a s antiphospholipid syndrome and myeloproliferative neoplasms, have high thromboembolism risks, and cause chronic lower limb artery occlusions as well as acute thrombotic occlusions [21][22][23] . Such systemic diseases may be an underlying cause of thrombotic occlusions in AI disease; therefore, they might be associated with high mortality in patients with thrombotic lesions.…”