Thrombosis of the Aorta Abdominalis in Infants – Diagnosis and Thrombolytic Therapy

Abstract

Background:

Aortic thrombosis is rarely observed in neonates and infants. Underlying conditions include the presence of umbilical artery catheters, thrombosed aneurysm of the ductus arteriosus, sepsis and different states of inherited thrombophilia. Treatment options include anticoagulation, thrombolytic therapy and thrombectomy. Due to the lack of large studies, neither diagnosis nor treatment of neonatal aortic thrombosis are standardized.

Patients:

From 2008–2010, 1 neonate and 1 infant were admitted to our hospital with symptomatic aortic thrombosis.

Methods and Results:

In both patients, diagnosis was made by Doppler ultrasound. Both patients were effectively treated with recombinant tissuetype plasminogen activator. Diagnosis and treatment of 2 infants with symptomatic aortic thrombosis are discussed and the literature is reviewed.

Conclusions:

Since aortic thrombosis is a lifethreatening condition, early diagnosis by Doppler ultrasound is mandatory to initiate treatment without delay. Thrombolytic therapy is a safe measure to treat this condition if administered with caution and if the patient has not suffered from serious complications such as mesenteric in­farction or renal failure prior to begin of therapy.

Zusammenfassung

Hintergrund:

Eine Thrombose der Aorta ist bei Neugeborenen und Säuglingen selten. Ursächlich sind Nabelarterienkatheter, Aneurysmen des Ductus arteriosus Botalli, Sepsis oder angeborene Thrombophilien. Als Therapie stehen Antikoagulation, Thrombolyse oder die Thrombektomie zur Verfügung. Aufgrund der geringen Patientenzahlen sind weder Diagnostik noch Therapie des Krankheitsbildes standardisiert.

Patienten:

2008 und 2010 wurden ein Neugeborenes und ein Säugling wegen einer sympto­matischen Thrombose der Aorta in unserer Klinik behandelt.

Methoden und Ergebnisse:

Die Diagnose ­wurde in beiden Fällen per Doppler-Ultraschall gestellt. Bei beiden Patienten führte die Behandlung mit rekombinantem Gewebeplasminogenaktivator zur effektiven Lyse des Thrombus.

Schlussfolgerung:

Da es sich bei einer Thrombose der Aorta um ein lebensbedrohliches Krankheitsbild handelt, sind im Neugeborenen- und Säuglingsalter die unverzügliche Diagnose mittels Doppler-Ultraschall und der schnellstmögliche Therapiebeginn entscheidend. Unter Berücksichtigung von Kontraindikationen ist die vorsichtige systemische Applikation von rekombinantem Gewebeplasminogenaktivator eine effektive Therapieoption.

Key words

aortic thrombosis - infants - thrombolysis - renal failure

Schlüsselwörter

Thrombose der Aorta - Säuglinge - Thrombolyse - Nierenversagen

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