Free-floating thrombus of the aorta: 3 case reports

Abstract

Background Idiopathic free-floating thrombus (FFT) of the aorta is a rare occurrence, but it can lead to catastrophic consequences. The initial symptoms are typically cerebral or peripheral embolisms. Surgical thrombectomy and thrombolysis are two primary treatments for FFT. Here, we report three cases of patients with idiopathic FFT in the absence of coagulopathy who were treated successfully by surgery with no recurrent thrombi or relapse of symptoms. Case presentation Case 1 involved a 72-year-old male patient with a pedunculated thrombus in the distal aortic arch. Case 2 involved a 62-year-old female patient with a cylinder thrombus in the aortic arch and left common carotid artery. Case 3 involved a 65-year-old male patient with three pedunculated thrombi in the ascending aorta, aortic arch, and left subclavian artery. None of the patients had clinical signs of coagulopathy. Pedunculated or cylinder thrombi have a greater risk of breaking off, which can produce severe peripheral embolism in contrast with intramural thrombi (73% vs. 12%). Due to the high embolism risk for each patient, conservative medical treatment by heparinization was deemed inappropriate, so each patient underwent emergency surgical thrombus removal. After surgery, each of the three patients was treated with warfarin for secondary prevention of thromboembolism. At 7-month follow-up in outpatient practice, a computed tomography (CT) scan indicated that Patient 1 had no recurrent thrombus, and the patient has been symptom-free for 11 months. At 1-month follow-up in outpatient practice, a CT scan indicated that Patient 2 had no recurrent thrombus, and the patient has been symptom-free for 8 years. At 3-week follow-up in hospital, a CT scan indicated that Patient 3 had no recurrent thrombus, but he failed to follow-up after discharge, so his follow-up status is unknown. Conclusions For a large pedunculated or cylinder thrombus located in the thoracic aorta, surgical thrombectomy should be performed. And, in surgical thrombectomy, the location of the cannulas and cross-clamp should be selected carefully according to the location of the thrombus. After surgery, anticoagulant is important to prevent recurrent idiopathic thrombi.

A floating mural thrombus in the ascending aorta can cause multiorgan infarction

“…Thrombectomy is often performed for pedunculated aortic mural thrombus 23–25. In the present case, thrombectomy was performed because of the high risk of recurrent embolism even under anticoagulation therapy.…”

“…In the present case, thrombectomy was performed because of the high risk of recurrent embolism even under anticoagulation therapy. A surgical approach is preferable if the location, mobility, and stemness of the thrombus suggest a high risk of embolic events 24 25. Therefore, early surgical treatment can be a helpful option for aortic mural thrombus.…”

Endovascular Treatment of Abdominal Aorta Floating Thrombus in a Patient with Recurrent Peripheral Embolization and COVID-19

“…The finding of a floating thrombus in the thoraco-abdominal aorta is rare life-threatening disease, mostly observed in the descending aorta or at the level of the aortic arch. As described in some case series in the literature, 19,20 the etiology of AFT is unclear.…”

“…Since the beginning of the pandemic of coronavirus disease (COVID- 19), increasing evidence suggests that severe acute respiratory syndrome coronavirus-2 (SARS CoV-2), might produce hypercoagulable state with subsequent arterial and venous thrombosis and thromboembolism, through various pathophysiological mechanisms, such as endothelial dysfunction, activation of coagulation cascade, immobilization, hypoxia and systemic inflammation. 1 Venous thromboembolism has been frequently described in severe cases, 2 conversely there are fewer reports of arterial thrombosis and embolism.…”

Endovascular removal of a large free-floating thrombus of the descending thoracic aorta using the AngioVac system

“…Open aortic surgical thrombectomy has been reported in several series. 3 , 4 , 5 , 6 , 7 , 8 , 9 Thrombus in the ascending aorta and transverse arch may necessitate hypothermic cardiopulmonary bypass with a short interval of circulatory arrest, with or without a short resection of the aortic wall. Open surgery for thrombus in the descending aorta usually requires left atrial or femoral bypass.…”