Unusual cause of recurrent arterial embolism: floating thrombus in the aortic arch surgically removed under hypothermic cardiocirculatory arrest

Abstract

A 46-year-old fully active, asymptomatic man suffered two episodes of major peripheral arterial embolism within 2 months. Heart disease was ruled out by appropriate investigations. Further diagnostic evaluation (angiography, CAT scan) revealed the extremely rare finding of a "floating mass" in the transverse aortic arch suspected to be the source of embolization. This mass was successfully removed using the technique of hypothermic cardiocirculatory arrest. The histological diagnosis was an aged intraluminal thrombus and moderate atherosclerosis of the thoracic aorta. For prevention of recurrent arterial embolism in cases without an initially apparent cause and site of origin, a thorough diagnostic, and in a given patient, an aggressive surgical approach for the elimination of the embolic source are advocated.

Transesophageal echocardiographic detection of aortic arch disease in patients with cerebral infarction.

“…A single observation was reported of a floating thrombus in the arch of the aorta surgically removed in a patient with recurrent peripheral emboli. 19 Thus, as reported in the literature and as we observed in the present study, a thrombus may develop in the aortic arch. Four of our present patients had elevated erythrocyte sedimentation rates and high serum fibrinogen at the onset of stroke that could indicate a hypercoagulable state.…”

A case of antiphospholipid syndrome presenting with a floating thrombus in the ascending aorta

“…This line of management was therefore abandoned, and an operation was recommended as the treatment of choice. Sadony and coworkers 5 have described successful removal of thrombus with hypothermic circulatory arrest. In our case, it was possible to remove the distal ascending aorta thrombus without hypothermic circulatory arrest by instituting cardiopulmonary bypass through bi-caval venous and axillary arterial cannulations.…”

Endovascular Therapy for Symptomatic Mobile Thrombus of Infrarenal Abdominal Aorta

“…25 However, in most cases, surgical intervention is warranted to avoid the risk of embolization or reembolization. 4,26 Commonly reported surgical interventions include aortotomy with thrombectomy, 2,3,21 local aortic endarderectomy, 15,26,27 aortic segmental resection, 26 aortotomy in combination with balloon embolectomy. 22 Transesophageal echocardiography-guided aortic balloon thrombectomy, 4 or interposition graft replacement of aorta.…”