{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:00:33Z","timestamp":1760148033479,"version":"build-2065373602"},"reference-count":27,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T00:00:00Z","timestamp":1679443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Mural aortic thrombosis associated with chronic peripheral obstruction of the lower limbs is an unusual event. Repeated embolism of instability aortic mural thrombosis caused acute limb ischemia (Rutherford 2 classification) in patients with peripheral arterial disease (PAD). We report a single-center experience for patients with transmural aortic thrombosis and peripheral artery disease. Methods: We retrospectively analyzed data of 54 patients with aortic mural thrombus disease with PAD presentation, treated at our center between 2013 and 2022. Results: Thirty patients (six with proven SARS-CoV-2 infection) underwent hybrid or staged treatment for an aortic lesion and for lower limb ischemia, by the placement of an endovascular aortic stent graft and a femoro-distal or a popliteal-distal bypass graft. The remaining 24 cases were only subjected to an intravascular treatment of the thoracic or abdominal aorta. Transient renal failure occurred in three patients. No embolic events were detected during the procedures. Aortic-related mortality was reported in just one patient who died from multiple organ failure. There was an embolic stroke in one patient with proven SARS-CoV-2 infection, three major amputations in patients with proven SARS-CoV-2 infection and no aortic-related mortality. Conclusions: Stent coverage of complex aortic lesions, alone or in association with a distal bypass graft, supports this approach in a variety of settings. The COVID-19 pandemic caused an increased mortality and amputation rate.<\/jats:p>","DOI":"10.3390\/diagnostics13061208","type":"journal-article","created":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T02:35:26Z","timestamp":1679538926000},"page":"1208","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Single-Center Experience with Simultaneous Mural Aortic Thrombosis and Peripheral Obstructive Disease in Pre-COVID-19 and COVID-19 Era"],"prefix":"10.3390","volume":"13","author":[{"given":"Filippo","family":"Benedetto","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences and of Morphological and Functional Image, University of Messina, 98100 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"La Corte","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and of Morphological and Functional Image, University of Messina, 98100 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico","family":"Spinelli","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and of Morphological and Functional Image, University of Messina, 98100 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9906-4658","authenticated-orcid":false,"given":"Gabriele","family":"Piffaretti","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, School of Medicine, Varese University Hospital, University of Insubria, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santi","family":"Trimarchi","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, University of Milano, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1859-9010","authenticated-orcid":false,"given":"Giovanni","family":"De Caridi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and of Morphological and Functional Image, University of Messina, 98100 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/01.sla.0000086663.49670.d1","article-title":"A national and single institutional experience in the contemporary treatment of acute lower extremity ischemia","volume":"238","author":"Eliason","year":"2003","journal-title":"Ann. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1053\/j.semvascsurg.2008.12.004","article-title":"Preoper evaluation and management of acute embolic versus thrombotic limb ischemia","volume":"22","year":"2009","journal-title":"Semin. Vasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.ejvs.2019.09.006","article-title":"Editor\u2019s Choice\u2014European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia","volume":"59","author":"Jongkind","year":"2020","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1016\/j.jvs.2014.08.057","article-title":"Contemporary management of symptomatic primary aortic mural thrombus","volume":"60","author":"Verma","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1136\/bmj.3.5566.655","article-title":"Embolism from mural thrombus in the thoracic aorta","volume":"3","author":"Oliver","year":"1967","journal-title":"Br. Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1007\/s10016-001-0314-2","article-title":"Mobile thrombus of the thoracic aorta: Diagnosis and treatment in 9 cases","volume":"16","author":"Choukroun","year":"2002","journal-title":"Ann. Vasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.ejvs.2010.11.004","article-title":"Thrombus in the non-aneurysmal, non-atherosclerotic descending thoracic aorta--an unusual source of arterial embolism","volume":"41","author":"Tsilimparis","year":"2011","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1177\/1538574413513845","article-title":"Endovascular management of a mobile thoracic aortic thrombus following recurrent distal thromboembolism: A case report and literature review","volume":"48","author":"Scott","year":"2014","journal-title":"Vasc. Endovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/S0741-5214(97)70045-4","article-title":"Recommended standards for reports dealing with lower extremity ischemia: Revised version","volume":"26","author":"Rutherford","year":"1997","journal-title":"J. Vasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1055\/s-2006-923976","article-title":"Arch thrombus formation in an apparently normal aorta as a source for recurrent peripheral embolization","volume":"54","author":"Berneder","year":"2006","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1007\/s00270-020-02676-2","article-title":"Thoracic Endovascular Aortic Repair in \u201cShaggy Thoracic Aortic Aneurysms\u201d","volume":"44","author":"Franchin","year":"2021","journal-title":"Cardiovasc. Interv. Radiol."},{"key":"ref_12","first-page":"503","article-title":"Recurrent lower limb embolism from thoracic aortic mural thrombus: A rare presentation of occult malignancy","volume":"11","author":"Mark","year":"2005","journal-title":"Hong Kong Med. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1007\/s100169900059","article-title":"Diagnosis and management of patients with peripheral macroemboli from thoracic aortic pathology","volume":"11","author":"Lau","year":"1997","journal-title":"Ann. Vasc. Surg."},{"key":"ref_14","first-page":"610","article-title":"The non-aneurysmal atherosclerotic abdominal aorta as a source of emboli: Report of a case","volume":"44","author":"Larrieu","year":"1978","journal-title":"Am. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1007\/s100169900220","article-title":"Primary aortic mural thrombus: Presentation and treatment","volume":"13","author":"Hahn","year":"1999","journal-title":"Ann. Vasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1067\/mva.2002.128933","article-title":"Surgical treatment of non aneurysmal aortic arch lesions in patients with systemic embolization","volume":"36","author":"Chaillou","year":"2002","journal-title":"J. Vasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1024\/0301-1526.36.2.121","article-title":"An unusual cause of peripheral artery embolism: Floating thrombus of the thoracic aorta surgically removed","volume":"36","author":"Schoebinger","year":"2007","journal-title":"Vasa"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1177\/1538574410363620","article-title":"Spontaneous aortic arch thrombus presenting as acute critical limb ischemia","volume":"44","author":"Adams","year":"2010","journal-title":"Vasc. Endovasc. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1016\/0002-8703(95)90160-4","article-title":"Detection of ascending aorta thrombi with transesophageal echocardiography in patients with systemic embolization","volume":"130","author":"Belkin","year":"1995","journal-title":"Am. Heart. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/S0167-5273(02)00509-0","article-title":"Systemic embolism from a large descending aortic thrombus","volume":"89","author":"Auer","year":"2003","journal-title":"Int. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1016\/j.jvs.2013.11.068","article-title":"Endovascular strategies for treatment of embolizing thoracoabdominal aortic lesions","volume":"59","author":"Jeyabalan","year":"2014","journal-title":"J. Vasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.jvs.2004.06.036","article-title":"The role of aortic stent grafting in the treatment of atheromatous embolization syndrome: Results after a mean of 15 months follow-up","volume":"40","author":"Carroccio","year":"2004","journal-title":"J. Vasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1007\/s10016-001-0278-2","article-title":"Treatment of embolizing arterial lesions with endoluminally placed stent grafts","volume":"16","author":"Shames","year":"2002","journal-title":"Ann. Vasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.thromres.2022.08.021","article-title":"Thromboembolic events in deceased patients with proven SARS-CoV2 infection: Frequency, characteristics and risk factors","volume":"218","author":"Voigtlaender","year":"2002","journal-title":"Thromb. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/S0140-6736(20)30937-5","article-title":"Endothelial cell infection and endothelitis in COVID-19","volume":"395","author":"Varga","year":"2020","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1007\/s11239-020-02332-z","article-title":"Delayed catastrophic thrombotic events in young and asymptomatic post COVID-19 patients","volume":"51","author":"Fan","year":"2021","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1002\/ajh.26384","article-title":"Late-onset hematological complications post COVID-19: An emerging medical problem for the ematologist","volume":"97","author":"Korompoki","year":"2022","journal-title":"Am. J. 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