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Floating intra-aortic thrombus presenting as distal arterial embolism
Dimitrios Pousios1, Theodoros Velissaris, Simon Duggan
1Department of Cardiothoracic Surgery, Wessex Cardiac Unit, Southampton General Hospital, Southampton, UK. dpousios@yahoo.com
Interactive Cardiovascular and Thoracic Surgery
|May 21, 2009
Summary
Floating aortic thrombi, rare without clotting issues, can cause limb ischemia. Surgical removal via cardiopulmonary bypass offers a safe and effective treatment with excellent outcomes.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Diagnostic Imaging
Background:
- Floating thrombi in the aorta are uncommon, particularly when no coagulation abnormalities are present.
- These thrombi can lead to serious complications such as peripheral embolism, presenting a surgical emergency.
Observation:
- A 45-year-old woman experienced acute upper extremity ischemia due to a free-floating thrombus in the ascending aorta.
- Computed tomography and magnetic resonance imaging confirmed the lesion, which was attached by a pedicle to the aortic wall.
- No underlying clotting disorder was identified in the patient.
Findings:
- Conservative management with anticoagulation failed to resolve the aortic thrombus.
- Surgical excision was performed using median sternotomy and cardiopulmonary bypass with hypothermic circulatory arrest.
- Histopathology confirmed the excised lesion to be a thrombus.
Implications:
- Surgical excision of aortic thrombi, even without coagulation abnormalities, is a viable and safe treatment option.
- This approach, involving cardiopulmonary bypass, can lead to excellent patient outcomes.
- Further research into the etiology and optimal management of such rare aortic thrombi is warranted.
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