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Published on: March 28, 2025
Primary Aortic Wall Myxoma Presenting With Recurrent Systemic Embolization: A Hybrid Surgical Management Strategy
Cecília Salazar Ulacia1, Marcelo Bellini Dalio1, Gabriel Bianco Giuliani2
1Division of Vascular and Endovascular Surgery, Department of Surgery and Anatomy, University of São Paulo, Ribeirão Preto Medical School, Ribeirão Preto, São Paulo, Brazil.
Background:
Primary aortic wall myxoma is exceptionally rare and may mimic mural thrombus or acute aortic dissection.
Case Summary:
A 38-year-old man presented after approximately 12 hours of acute left lower-limb ischemia with concomitant left upper-limb occlusion. Computed tomography angiography showed filling defects in the ascending and descending thoracic aorta. Recurrent embolization after peripheral thromboembolectomy prompted emergency ascending aortic exploration. A friable intramural myxoma was excised with ascending aortic graft replacement; the descending lesion was excluded by staged thoracic endovascular aortic repair while therapeutic anticoagulation was maintained.
Discussion:
Histopathology confirmed an aortic wall myxoma. The case illustrates the limitations of imaging and an individualized hybrid strategy for suspected multifocal aortic involvement.
Take-Home Messages:
Recurrent embolization after embolectomy should prompt urgent proximal-source control. Hybrid repair may be considered when anatomy and clinical urgency support it.
