Spontaneous Aortic Arch Thrombus Presenting as Acute Critical Limb Ischemia

Abstract

We report a case of a 52-year-old male who presented with acute leg ischemia and underwent successful femoral embolectomy and fasciotomies. Investigations revealed a pedunculated mass in the aortic arch, floating under the innominate and left common carotid arteries. Urgent resection was performed through a longitudinal aortotomy with deep hypothermic circulatory arrest and axillary artery perfusion to reveal a 2.5 x 1.5 cm pedunculated mass attached to the posterior aspect of the arch that was resected. Histology revealed thrombus material prompting lifelong systemic anticoagulation. On 3 months follow-up, the patient had returned to normal activities and computed tomography confirmed complete resection without recurrence. This case study demonstrates that spontaneous thrombus formation is possible in high-flow vascular regions such as the aortic arch and also confirms the importance of evaluating central sources of thromboemboli in patients presenting with acute limb ischemia. Urgent surgical removal is recommended and can be performed safely.

Single-Center Experience with Simultaneous Mural Aortic Thrombosis and Peripheral Obstructive Disease in Pre-COVID-19 and COVID-19 Era

“…A relatively small number of publications, including case reports and small case series, describing patients with thrombus in a non-aneurysmal minimally atherosclerotic either thoracic or abdominal aorta have been published [ 10 ], while more recent experiences focus on the outcomes in conditions of an atherosclerotic and “shaggy” aorta [ 11 ]. Acute symptoms from peripheral embolism were the most frequent manifestation [ 6 , 7 , 8 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Diagnosis of this pathology is first based on the clinical evaluation of peripheral symptoms and signs, if present.…”

Acute peripheral ischemia in healthy female patient: an indirect and unanticipated diagnosis of spontaneous thrombus in the aortic arch

“…Spontaneous Aortic Arch thrombus is a rare but previously in literature described origin for peripheral embolization [1]. Common causes leading to aortic thrombus formation are congenital or acquired blood disorders, tumor, inflammation, hormone therapy, steroid use or structural abnormalities in the aortic wall, myxoma, fibroelastoma as well as persistent foramen ovale [2].…”

Massive Thoracoabdominal Aortic Thrombosis in a Patient with Iatrogenic Cushing Syndrome

“…Particularly, the formation of a friable floating thrombus in the proximal aortic arch creates a life-threatening risk of stroke and peripheral embolization (1, 2, 3, 4, 5). Here, we present the case of an 82-year-old woman with massive thoracoabdominal aortic thrombosis secondary to iatrogenic Cushing syndrome.…”