Endovascular stent grafting of a thoracic aortic mobile thrombus with embolic phenomenon

Descending thoracic aortic mural thrombus presentation and treatment strategies

“…Furthermore, some authors suggest the use of certain techniques to avoid such complications, such as aortography through a subclavian approach to visualize the thrombus shadow, intravascular ultrasound, temporary balloon occlusion of selected visceral vessels, and a seal zone at least 2 cm proximal and distal to the thrombus. 24,25,32,37 It is unclear whether the lack of reported embolic phenomena is a result of selection bias in that TEVAR was reserved for patients with favorable anatomy and a smaller area of coverage required, whereas patients with a large clot burden were initially selected to undergo a trial of medical management in an attempt to reduce their clot burden or were determined to be candidates for open surgical repair. It is clear, however, that TEVAR has been beneficial for patients in a variety of scenarios and can be used successfully for high-risk patients with aortic thrombus presenting with embolization, symptomatic patients, patients with recurrent embolization, and patients who have a contraindication to or are unresponsive to anticoagulant therapy.…”