International Journal of Cardiovascular and Thoracic Surgery

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Endovascular Therapy for Thoracic Aortic Mobile Thrombus

Received: 20 January 2024    Accepted: 19 February 2024    Published: 29 February 2024
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Abstract

Thoracic aortic mobile thrombus (TAMT) in the absence of atherosclerosis, traumatic injury, or thrombophilia represents an uncommon but well-acknowledged form of a non-cardiogenic thromboembolic source. The morbidity and mortality of acute visceral thromboembolism from an aortic thrombus remains elevated, though delay in diagnosis is common given its underappreciated source as a potentially catastrophic aetiology. Nomenclature to describe any thromboembolism to abdominal viscera remains varied throughout the literature with a cardiac source from arrhythmias most prevalent. Computerized tomographic angiogram (CTA) of chest and abdomen is the modality that most commonly diagnoses TAMT. Trans-esophageal echocardiography (TEE), however, has been the imaging modality of choice in defining the specific thrombus morphology of TAMT. Patient morbidity and mortality of TAMT may entail devastating thromboembolism to myriad sites: cerebrum, mesentery, renal and upper and/or lower extremity peripheral vasculatures. Risks factors of developing aortic mural thrombus are explored within each case. Herein are two illustrative cases of TAMT presenting with acute peritoneal signs and symptoms of visceral ischemia, respectively involving spleen and kidney in the first, and spleen and intestine, the second case. Both cases were successfully managed by physical examination, CTA-diagnosis, intravascular ultrasound (IVUS) to define the morphology of the aortic thrombus, and subsequent thoracic endovascular aortic repair (TEVAR) graft deployment.

DOI 10.11648/j.ijcts.20241001.11
Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 10, Issue 1, February 2024)
Page(s) 1-5
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Visceral Thromboembolism, Arterial Thromboembolism, Aortic Thrombi, Acute Abdomen

References
[1] Weismann RE, Tobin RE. Arterial embolism occurring during systemic heparin therapy. Arch Surg 1958; 76: 219-227.
[2] Williams GM, Harrington D, Burdick, J, White, RI. Mural Thrombus of the Aorta: An important, Frequently Neglected Cause of Large Peripheral Emboli. Ann Surg 1981; 194 (6): 737-744.
[3] Machleder HI, Takiff H, Lois JF, Holburt E. Aortic Mural Thrombus: an occult source of arterial thromboembolism. J Vasc Surg. 1986; 4: 473-478.
[4] Boufi M, Mameli A, Compes P, Hartung O, Alimi YS. Elective Stent-graft Treatment for the Management of Thoracic Aorta Mural Thrombus. Eur J Vasc Endovasc Surg 2014; 47 (4): 335-341.
[5] Verma H, Meda N, Vora S, George RK, Tripathi RK. Contemporary Management of Symptomatic Primary aortic Mural Thrombus. J Vasc Surg 2014; 60: 1524-1534.
[6] Turley RS, Unger J, Cox MW, Lawson J, McCann RL, Shortell C. Atypical Aortic Thrombus: Should Nonoperative Management Be First Line? Ann Vasc Surg 2014; 28(7): 1610-1617.
[7] Borghese O, Pisani A, Di Centa. Symptomatic Aortic Mural Thrombus Treatment and Outcomes. Ann Vasc Surg 2020; 69: 373-381.
[8] Criado E, Wall P, Lucas P, Gasparis A, Profitt T, Ricotta J. Transesophageal echo-guided endovascular exclusion of thoracic aortic mobile thrombi. J Vasc Surg 2004; 39: 238-242.
[9] Siani A, Accrocca F, De Vivo G, Mounayergi F, Marcucci G. Endovascular Treatment of Symptomatic Thrombus of the Descending Thoracic Aorta. Ann Vasc Surg 2016; 36: 295e13-16.
[10] Piffaretti G, Tozzi M, Mariscalco G, Bacuzzi A, Lomazzi C, Rivolta N, Carrafiello G, Castelli P. Mobile Thrombus of the Thoracic Aorta: managemtn and Treatment Review. Vasc Endovasc Surg 2008; 42(5): 405-411.
[11] Fueglistaler P, Wolff T, Guerke L, Stierli P, Eugster T. Endovascular stent graft for symptomatic mobile thrombus of the thoracic aorta. J Vasc Surg 2005; 42: 781-783.
[12] Bukharovich IF, Wever-Pinzon O, Shah A, Todd G, Chaudhry FA, Sherrid MV. Echocardiography 2012; 29(3): 369-372.
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  • APA Style

    Roberts, J. G. (2024). Endovascular Therapy for Thoracic Aortic Mobile Thrombus. International Journal of Cardiovascular and Thoracic Surgery, 10(1), 1-5. https://doi.org/10.11648/j.ijcts.20241001.11

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    ACS Style

    Roberts, J. G. Endovascular Therapy for Thoracic Aortic Mobile Thrombus. Int. J. Cardiovasc. Thorac. Surg. 2024, 10(1), 1-5. doi: 10.11648/j.ijcts.20241001.11

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    AMA Style

    Roberts JG. Endovascular Therapy for Thoracic Aortic Mobile Thrombus. Int J Cardiovasc Thorac Surg. 2024;10(1):1-5. doi: 10.11648/j.ijcts.20241001.11

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  • @article{10.11648/j.ijcts.20241001.11,
      author = {James Gregory Roberts},
      title = {Endovascular Therapy for Thoracic Aortic Mobile Thrombus},
      journal = {International Journal of Cardiovascular and Thoracic Surgery},
      volume = {10},
      number = {1},
      pages = {1-5},
      doi = {10.11648/j.ijcts.20241001.11},
      url = {https://doi.org/10.11648/j.ijcts.20241001.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20241001.11},
      abstract = {Thoracic aortic mobile thrombus (TAMT) in the absence of atherosclerosis, traumatic injury, or thrombophilia represents an uncommon but well-acknowledged form of a non-cardiogenic thromboembolic source. The morbidity and mortality of acute visceral thromboembolism from an aortic thrombus remains elevated, though delay in diagnosis is common given its underappreciated source as a potentially catastrophic aetiology. Nomenclature to describe any thromboembolism to abdominal viscera remains varied throughout the literature with a cardiac source from arrhythmias most prevalent. Computerized tomographic angiogram (CTA) of chest and abdomen is the modality that most commonly diagnoses TAMT. Trans-esophageal echocardiography (TEE), however, has been the imaging modality of choice in defining the specific thrombus morphology of TAMT. Patient morbidity and mortality of TAMT may entail devastating thromboembolism to myriad sites: cerebrum, mesentery, renal and upper and/or lower extremity peripheral vasculatures. Risks factors of developing aortic mural thrombus are explored within each case. Herein are two illustrative cases of TAMT presenting with acute peritoneal signs and symptoms of visceral ischemia, respectively involving spleen and kidney in the first, and spleen and intestine, the second case. Both cases were successfully managed by physical examination, CTA-diagnosis, intravascular ultrasound (IVUS) to define the morphology of the aortic thrombus, and subsequent thoracic endovascular aortic repair (TEVAR) graft deployment. 
    },
     year = {2024}
    }
    

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    JO  - International Journal of Cardiovascular and Thoracic Surgery
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    AB  - Thoracic aortic mobile thrombus (TAMT) in the absence of atherosclerosis, traumatic injury, or thrombophilia represents an uncommon but well-acknowledged form of a non-cardiogenic thromboembolic source. The morbidity and mortality of acute visceral thromboembolism from an aortic thrombus remains elevated, though delay in diagnosis is common given its underappreciated source as a potentially catastrophic aetiology. Nomenclature to describe any thromboembolism to abdominal viscera remains varied throughout the literature with a cardiac source from arrhythmias most prevalent. Computerized tomographic angiogram (CTA) of chest and abdomen is the modality that most commonly diagnoses TAMT. Trans-esophageal echocardiography (TEE), however, has been the imaging modality of choice in defining the specific thrombus morphology of TAMT. Patient morbidity and mortality of TAMT may entail devastating thromboembolism to myriad sites: cerebrum, mesentery, renal and upper and/or lower extremity peripheral vasculatures. Risks factors of developing aortic mural thrombus are explored within each case. Herein are two illustrative cases of TAMT presenting with acute peritoneal signs and symptoms of visceral ischemia, respectively involving spleen and kidney in the first, and spleen and intestine, the second case. Both cases were successfully managed by physical examination, CTA-diagnosis, intravascular ultrasound (IVUS) to define the morphology of the aortic thrombus, and subsequent thoracic endovascular aortic repair (TEVAR) graft deployment. 
    
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Author Information
  • Surgical Phronesis, Vascular Surgery, Monterey, United States

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