Atypical Aortic Thrombus: Should Nonoperative Management Be First Line?

Contemporary management of symptomatic primary aortic mural thrombus

“…Type IIa has been the most common type of PAMT described in the past. [1][2][3][4][5][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] The junction of the distal aortic arch and descending thoracic aorta has been shown to have a predilection for aortic mural thrombus, although its exact cause is not known. The possibility of an embryologic defect at the aortic isthmus and shear, bending, and torsion stresses 26 attributed to aortic trauma during blunt chest injuries have been described.…”

A case of massive aortic mural thrombus in the absence of atherosclerotic or aneurysmal disease

“…For these reasons, it was suggested that patients at a higher risk of recurrence be treated with aortic surgery as an aggressive first-line treatment option. In contrast, Turley et al [1] found that as our knowledge of the aetiology of AMT in relation to hypercoaguable states increased, so too did the indication for a conservative first-line approach. They cited improved success rates with the use of thrombolysis and long-term therapeutic anticoagulation with a significant reduction in the complication rate and length of hospital stay compared with surgical intervention 1 .…”

“…In most cases described in the limited literature available there was an undiagnosed hypercoagulable state. This highlights the need to exclude malignancy, inflammatory bowel disease, haematologic disorders and exogenous steroid use [1], [2] in these patients. In our case there was no active history of smoking, atherosclerosis wasn't seen on imaging, there was no malignancy and the thrombophilia screen was negative.…”

A critical reappraisal of the treatment modalities of normal appearing thoracic aorta mural thrombi

“…Additional to the failed anticoagulant treatment, mobile thrombi, large thrombi and recurrent embolisms have been proposed as indications for surgical approach (45). However, the surgical options are not complication-free with a reported mortality of 2.6% (19) and perioperative complications ranging from 28.9% to 71% (45,46). This was the main reason why some investigators do not consider operative management of aortic thrombus as first-line management (25,31).…”