Hybrid management of primary aortic mural thrombus with mesenteric embolization

Primary aortic mural thrombus with visceral embolization is a rare and life-threatening condition without an established treatment strategy. We report the case of a 40-year-old woman with thoracoabdominal primary aortic mural thrombus and embolization to the superior mesenteric and common hepatic arteries. She was treated using a hybrid approach consisting of large-bore aspiration thrombectomy with the Symphony Thrombectomy System (Imperative Care, Inc), temporary aortic flow control using a trilobed occlusion balloon, intravascular ultrasound-guided thoracic endovascular aortic repair, and selective conversion to open superior mesenteric artery thrombectomy with patch angioplasty. The patient recovered without bowel resection or distal embolic complications, demonstrating the feasibility of this staged hybrid strategy.