Abstract
BackgroundIn this case we discuss the management of a pediculated floating thrombus in the aortic arch which led to peripheral embolization and acute ischemia oft he left leg.Case presentationA healthy 46 year old female patient presented with pain in her left leg and progressive numbness. Computed Tomography Angiography (CTA) showed an acute ischemia of the left leg (Rutherford 2 B) with a 2 cm thrombus distal of the aortic bifurcation. Emergency operation with embolectomy, selective thrombembolectomy and patch plasty on the tibioperoneal trunk and local lysis was performed. As part of a further diagnostic examination a thoracic CT scan has been performed revealing a pediculated-floating 2 cm thrombus in the aortic arch. Four days after the initial operation thrombus excision via a minimally invasive access way has been performed. After initiation of the extracorporeal circulation, selective unilateral antegrade cerebral perfusion has been established in mild (30–32 °C) systemic hypothermia. Patients postoperative course was uneventful. Histological evaluation of the mass demonstrated thrombotic material without evidence of infection or malignacy.ConclusionA pediculated spontaneous thrombus may develop in aortic arch in patients without traditional risk factors or family history of embolic events. Two stage operation was feasible and safe.
Highlights
Peripheral embolization of a thrombus fragment located in the aortic arch is a rare finding in clinical practice
In the current manuscript we aimed to report and discuss the surgical management of a pediculatedfloating 2 cm thrombus in the aortic arch which already
Case A 46 year old female patient presented with pain in her left leg and progressive numbness
Summary
Peripheral embolization of a thrombus fragment located in the aortic arch is a rare finding in clinical practice. Case A 46 year old female patient presented with pain in her left leg and progressive numbness. She has no history of valvular heart disease, atrial fibrillation, hypercoagulable disorder, peripheral vascular disease or claudication. As part of a further diagnostic examination, a thoracic CT scan has been performed revealing a pediculated-floating 2 cm thrombus in the aortic arch (zone 0, Fig. 2). Postoperative transthoracic echocardiography was without pathological findings In this case we discuss the management of a pediculated floating thrombus in the aortic arch which led to peripheral embolization and acute ischemia oft he left leg. Computed Tomography Angiography (CTA) showed an acute ischemia of the left leg (Rutherford 2 B) with a 2 cm thrombus distal of the aortic bifurcation. Histological evaluation of the mass demonstrated thrombotic material without evidence of infection or malignacy
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