Thoracic Aortic Mobile Thrombus: Is There a Role for Early Surgical Intervention?

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…CTA and MRA can provide additional and more detailed information. 296,297 The treatment strategy for this disease remains controversial and is determined by the location and extension of the thrombus, presence of complications, the patient's comorbidities, and the physician's preferences. Options include anticoagulant therapy, aspiration thrombectomy, surgical thrombectomy, or endovascular repair by covered stent deployment.…”

“…297 On the other hand, early intervention with thoracic aortic thrombectomy has been shown to prevent fatal recurrent embolic events. 296 Less invasive surgical approaches have been proposed, including TOE guided trans-aortic and trans-femoral balloon thrombectomy, percutaneous catheter thrombo-aspiration, and TOE guided thrombus exclusion using endovascular covered stents. 298 Endovascular exclusion of the thrombus from the systemic circulation by stent graft deployment is certainly an attractive approach in high risk surgical patients with favourable anatomy, although the possibility of thrombus fragmentation and dislodgement by catheter manipulation should also be considered.…”

“…Options include anticoagulant therapy, aspiration thrombectomy, surgical thrombectomy, or endovascular repair by covered stent deployment. 296 If anticoagulation is selected, a size reduction of thrombus should be observed in a short time and heparin treatment must be maintained or switched to oral anticoagulation until the thrombus is completely dissolved. When no reduction in thrombus size is observed, or if the thrombus appears mobile within the aortic lumen, a more aggressive treatment strategy should be recommended.…”

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

“…1 Although the natural history of TAMT is poorly understood, diagnosis is usually made after evaluation of established embolic sequelae. 2 Whilst optimal management remains controversial, we present a case of TAMT with embolic phenomenon treated with an endovascular stent graft.…”

Acute Aortic Occlusion by Massive Piling-Up of Large Unstable Thoraco-Abdominal Thrombi Attributable to Heparin-Induced Thrombocytopenia

“…Her low-molecular-weight heparin was immediately replaced with Danaparoid sodium given the suspicion of heparin-induced thrombocytopenia. A complete aortic thrombectomy under extracorporeal circulation 1 and through thoraco-phreno-laparotomy was planned for the very next days after cardiac and pulmonary functions tests could be done.…”