Mobile thrombus of the abdominal aorta: a narrative review

Abstract

A primary aortic mural thrombus (PAMT) is defined as a thrombus attached to the aortic wall in the absence of any atherosclerotic or aneurysmal disease of the aorta or any cardiac source of embolus. It is a rare entity that has high morbidity and mortality. There is no consensus on the ideal treatment of PAMT. The objective of this paper is to review the possibilities for treatment of mobile abdominal aortic mural thrombus. Endovascular therapy and open surgery appear to be the best options for treatment of mobile abdominal aortic mural thrombus. Thus, in patients with favorable anatomy, endovascular therapy is probably the treatment choice, while in those with unfavorable anatomy, open surgery is probably the best option for treatment of a mobile abdominal aortic thrombus. It is important to emphasize that anticoagulation alone can be used as a non-aggressive option and, if this fails, endovascular or surgical methods can then be employed.

Thromboaspiration of Abdominal Aortic Mural Thrombus: A New Endovascular Approach

“…Reviews tend to favor invasive treatment over non-operative approaches. 7,9,14 Regarding endovascular treatment, the use of an endoprothesis to exclude the thrombus from the circulation and the direct thrombectomy are the main options. 5 Thromboaspiration may be particularly helpful and successful in treating mobile or pedunculated thrombus, while endoprosthesis implantation seems to be more suitable for cases associated with large burden of non-mobile mural thrombus or large segments of the vessel involved.…”