Management Strategies for Descending Thoracic Aortic Thrombus: A Review of the Literature

Nguyen, Quynh; Ma, Xiya; Vervoort, Dominique; Luc, Jessica G.Y.

doi:10.1177/15569845221107011

Cited by 3 publications

(6 citation statements)

References 62 publications

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“…The formation of a TAMT in the absence of significant atherosclerosis is a rare yet potentially life-threatening condition. TAMTs are increasingly considered a source of peripheral embolization [ 7 ]. Only a few hundred cases are described in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Thrombi can form along the ascending, descending, or arch of the aorta, though most develop in the proximal descending thoracic aorta (38%) [ 7 ]. TAMT may occur in a normal, undiseased aorta or in one with demonstrated atherosclerosis [ 5 , 7 ]. The underlying pathophysiology is multifactorial, but Virchow’s triad of thrombosis plays a role.…”

Section: Discussionmentioning

confidence: 99%

“…Minimally invasive approaches such as thoracic endovascular aortic repair (TEVAR) may also be considered in patients with failure of conservative measures, worsening clinical course, recurrent thrombus after surgery, or poor overall surgical candidacy. TEVAR was noted to successfully achieve thrombus resolution, regression, or exclusion in 80% of individuals but still carried a risk of subsequent embolization [ 7 ]. In patients with an underlying hypercoagulable state, both surgical and medical approaches have been utilized, but the general consensus is that at least a trial, if not indefinite, prescription of anticoagulation should entail endovascular, open surgical, and minimally invasive options reserved when conservative management fails [ 1 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical sequelae including stroke, spinal cord ischemia, visceral infarction, and acute limb ischemia associated with TAMT are destructive [ 1 , 7 ]. Computed tomography (CT), echocardiography, magnetic resonance imaging (MRI), and angiography are modalities used to capture and diagnose this condition.…”

Section: Introductionmentioning

confidence: 99%

“…Given the paucity of cases, there are no established guidelines for treatment. However, typical management involves therapeutic anticoagulation, medical thrombolysis, endovascular intervention, or surgical management [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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A Case of Thoracic Aortic Mural Thrombus and Multiple Hypercoagulable Etiologies

Wagner,

Lantz

2024

Cureus

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Thoracic aortic mural thrombi (TAMT) are rare yet a significant cause of emboli and mortality. Hypercoagulability is thought to play a role in pathogenesis. A common association is prothrombin G20210A mutation. We present a case of an 87-year-old man with an incidentally found TAMT in the setting of prothrombin mutation, metastatic prostate cancer, and a myeloproliferative disorder. The patient had several causes activating Virchow's hypercoagulability principle, contributing to a centrally located clot. Because of its paucity in the literature, we advocate for further research concerning treatment modalities of TAMTs as well as an additional and timely workup for hypercoagulable states to prevent further calamity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Case of Thoracic Aortic Mural Thrombus and Multiple Hypercoagulable Etiologies

Wagner,

Lantz

2024

Cureus

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A Free-Floating Aortic Thrombus: An Uncommon Approach to Handle a Rare Clinical Entity

Grassl,

Hangler,

Gratl

et al. 2024

J Endovasc Ther

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Background: Thrombotic material in the non-aneurysmatic and non-atherosclerotic aorta is a rare entity without any recommended standard treatment so far. We present a successful treatment strategy for patients who do not fit into any of the common approaches. Case report: A free-floating thrombus in the descending aorta was found as source of embolism in an 82-year-old female patient with lower limb ischemia. After initial heparinization of the patient without relevant reduction of the thrombotic mass, the thrombus was removed using an interdisciplinary approach. Under echocardiographic guidance to locate the thrombus, the AngioVac device, usually licensed to remove floating thrombi from the venous system, was used off-label to remove the thrombus by a transfemoral approach. To avoid rebuilding of a new thrombus, the attachment point with an exulcerated plaque in the descending aorta was covered by a stent graft via the same femoral access. The patient did not experience any further embolic events, and the postoperative course was uncomplicated. Conclusion: Patients with uncommon aortic diseases, such as the reported free-floating thrombus, should be treated by an individualized, interdisciplinary approach. Besides the recommended treatment options, there are other uncommon approaches that might offer an alternative in complex cases. Clinical Impact Evidence is rare for the treatment of a free-floating thrombus in the descending aorta and the treatment strategy remains discussed controversially. We present a rather uncommon approach of successful off-label treatment for patients who do not fit into any of the common approaches (operative, endovascular, or conservative treatment based on patient’s comorbidities). The AngioVac System has already been successfully used off-label in the arterial system but not in the above presented way of treating a free-floating thrombus in a patient with high embolization risk and treatment-limiting comorbidities.

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Endovascular solutions for symptomatic free-floating thrombus in thoracic aorta in rheumatoid arthritis patients: Two clinical cases

Mastrangelo,

Di Sebastiano,

Palazzo

2024

Vascular

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Objectives We present two clinical cases of association between symptomatic free-floating thrombus (FFT) in thoracic aorta and rheumatoid arthritis (RA). Methods In the first patient, we observed a recent onset of peripheral and visceral signs of embolization: after a first treatment with anticoagulation, our Aortic team scheduled the coverage of FFT (sited in zone 1 of the aortic arch) with an anatomical debranching of anonymous trunk and left carotid artery, a left carotid-subclavian bypass, and a TEVAR of the aortic arch with proximal landing in zone 0 of the arch. The second case was characterized by chest pain, left upper limb ischemia, and CTA evidence of an FFT in zone 3 of the aortic arch; we planned a chimney-TEVAR on the left subclavian artery and descending thoracic aorta (with proximal landing in zone 2 of the aortic arch) to exclude the FFT. Results No complications resulted and no new embolic episodes were registered. Conclusions Evaluating the aorta is warranted in all patients with peripheral emboli of uncertain pathogenesis. In our opinion, the endovascular treatment of a symptomatic FFT could represent an effective and safe solution in a patient fit for endovascular surgery, but larger studies are required to define a personalized treatment strategy.

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Management Strategies for Descending Thoracic Aortic Thrombus: A Review of the Literature

Cited by 3 publications

References 62 publications

A Case of Thoracic Aortic Mural Thrombus and Multiple Hypercoagulable Etiologies

A Case of Thoracic Aortic Mural Thrombus and Multiple Hypercoagulable Etiologies

A Free-Floating Aortic Thrombus: An Uncommon Approach to Handle a Rare Clinical Entity

Endovascular solutions for symptomatic free-floating thrombus in thoracic aorta in rheumatoid arthritis patients: Two clinical cases

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