[Thoracic Endovascular Aortic Repair for Intra-aortic Thrombosis in the Distal Arch]

An 81-year-old woman was referred to our hospital due to anorexia and low-grade fever for the past two weeks, and was urgently hospitalized since a computed tomography (CT) scan revealed a thrombus in the greater curvature of the distal aortic arch and proximal descending aorta. However, because of her fraility and poor general condition, surgery was not indicated at the time of admission, and anticoagulation therapy was initiated awaiting recovery of her condition. Considering the patient's age and comorbidities, thoracic endovascular aortic repair (TEVAR) was selected after thorough consultation with the family. In this case, because the device had to be passed through the lesser curvature of the aortic arch to prevent thromboembolisms, the left fifth intercostal space was opened and a tug of wire was established between the apex of the heart and the right groin. By using this technique, device deploy could be carried out without thromboembolisms. The patient was discharged from hospital without any perioperative embolic complications and is currently followed-up at the outpatient clinic.