Endovascular treatment for mobile thrombus of the thoracic aorta

Abstract

Detection levels of mobile thrombus of the thoracic aorta have greatly increased after any embolic event. Although the indication for treatment remains controversial, there is a growing interest about the etiopathogenesis of this rare entity and to define proper diagnostic and therapeutic approaches. We present a case of mobile thrombus of the thoracic aorta causing recurrent peripheral emboli managed with endovascular stent graft. #

Endovascular Management of a Mobile Thoracic Aortic Thrombus Following Recurrent Distal Thromboembolism

“…9,10 Although experiences are currently limited to few case reports (and with resultant reporting bias), the early results have been promising with 100% technical success, no early recurrences, and no wire or device complications (including leak, aberrant placement, migration, or wire complications to include inadvertent embolism; Table 1). 9,[11][12][13][14][15][16][17] Nevertheless, several considerations should be made when approaching these lesions. These include (1) careful management of wires to prevent iatrogenic emboli; (2) use of angiography (via left subclavian) and/ or intravascular ultrasonography to accurately identify and exclude the affected segment of aorta; (3) planning of at least 1 to 2 cm proximal and distal landing zone/overlap; (4) postprocedural evaluation of mesenteric and lower extremity vessels.…”

The challenge of posttraumatic thrombus embolization from abdominal aortic aneurysm causing acute limb ischemia

“…Several authors [12][13][14][15][16][17] have reported positive endovascular experience with the endovascular treatment of unstable thoracic aortic thrombi. In the field of abdominal aorta, Zhang et al 18 recently described simultaneous endovascular treatment of thoracic and abdominal mobile thrombi, using the large size introducer sheaths to prevent distal embolization.…”

Floating aortic arch thrombus involving the supraaortic trunks: Successful treatment with supra-aortic debranching and antegrade endograft implantation

“…17 Surgery requires careful analysis of CTA, which has replaced TEE as the diagnostic modality and planning tool of choice. [3][4][5][6][7] Before any VORTEC procedure, we carefully analyze the CTA studies and reconstructions to detect potential problems and plan for the optimal puncture site. In this patient, the thrombus extended from the aortic arch within the first 2 cm of LCCA origin.…”

“…2 Since then, several authors have reported their experience with endograft implantation. [2][3][4][5][6][7][8] In all but one 8 of these patients, treatment was limited to the descending aorta, 2-7 and in most patients, the proximal landing zone of the endograft was located distal to the left subclavian artery and never crossed the LCCA. In our patient, endovascular exclusion of the arch thrombus required coverage of the entire arch (ascending aorta to descending aorta), necessitating a preliminary debranching of the supra-aortic vessels.…”

“…1 Endovascular exclusion of such mobile thrombus has already been described, 2-8 but exclusively involved the descending aorta [2][3][4][5][6][7] ; or debranching of the supraaortic trunk was done by open surgical bypass procedure. 8 We present a patient with a floating thrombus that extended throughout the whole aortic arch and involved all of the supraaortic trunks.…”