Successful Removal of a Floating Thrombus in Ascending Aorta

Catching a floating thrombus; a case report on the treatment of a large thrombus in the ascending aorta

“…While the dimensions of the thrombus are never considered as main criterion, the location of thrombus strongly affects the possible surgical strategies. Thrombus removal under circulatory arrest and deep hypothermia has been proposed [3] as well as with normothermic aortic cross clamping [4]. In our case, thrombus was located in the distal ascending aorta, with inherent concerns.…”

Surgical Treatment of a Floating Thrombus of the Ascending Aorta Causing Repeated Arterial Embolisms

“…Auricular fibrillation, ventricular aneurysms, infectious or rheumatic valve pathologies, and prosthetic valves are also responsible for arterial embolism. 1 Noncardiac thrombi are generally related to an atheromatous plaque of the wall of the aorta or large arteries or a paradoxical embolism. Floating thrombi of the ascending aorta are rare and seldom described as the cause of peripheral arterial embolisms.…”

Thoracic Endovascular Aortic Repair in a Patient with Mobile Aortic Thrombosis

“…Commonly encountered cardioembolic presentations include stroke [3–6], an acutely threatened limb or blue toe syndrome [7, 8], and abdominal ischaemic syndromes [3, 9–11], including renal or splenic infarcts and mesenteric ischaemia. However, a few authors have reported asymptomatic TAMT following thoracic CTA done for unrelated reasons, including to rule out pulmonary emboli or an acute traumatic aortic syndrome [12, 13].…”

“…The age at presentation varies between case series, with a 14-patient case series by Pagni et al having an average age of 50.6 years, with no significant predilection for either gender [3]. TAMT may develop on an underlying diseased aorta due to underlying atheroma, aortic dissection, intimal flap, or aortitis [3, 5, 7, 9, 14]. Occasionally, TAMT may develop on what appears to be a normal underlying aorta.…”

“…Treatment of this rare entity has not been established or tested in case control trials or large meta-analyses. Many authors have reported resolution of clot and no further thromboembolism with anticoagulation with or without antiplatelet agents alone [3, 4, 6–8, 12, 13], while others have also had success with open surgical thrombectomy and postoperative anticoagulation [3, 6, 9, 10, 14], with the added benefit of addressing the organised thrombus component which is unlikely to respond to anticoagulation but at a risk of increased perioperative morbidity and mortality. A number of authors have, on the basis of trends in the literature, recommended early surgical over medical therapy.…”