Acute peripheral ischemia in healthy female patient: an indirect and unanticipated diagnosis of spontaneous thrombus in the aortic arch

• Published in: Journal of cardiothoracic surgery 2020-10, Vol.15 (1), p.288-288, Article 288
• Main Authors: Rings, Laura, Schwegler, Igor, Papadopoulos, Nestoras, Häussler, Achim, Odavic, Dragan, Schmidt, Magdalena, Dzemali, Omer
• Format: Article
• Language: English
• Subjects: Abdomen; Acute Disease; Angiography; Anticoagulants; Aorta; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic arch; Aortic Diseases - complications; Aortic Diseases - diagnostic imaging; Aortic Diseases - surgery; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - etiology; Arterial Occlusive Diseases - surgery; Aspirin; Atherosclerosis; Bifurcations; Blood clots; Cardiac arrhythmia; Cardiovascular Surgical Procedures - methods; Case Report; CAT scans; Cerebral blood flow; Computed tomography; Computed Tomography Angiography; Congenital diseases; Coronary vessels; Diagnosis; Diagnostic systems; Disease; Electrocardiography; Embolectomy; Embolism - diagnostic imaging; Embolism - etiology; Embolism - surgery; Embolization; Emergency procedures; Etiology; Female; Genetics; Humans; Hypothermia; Ischemia; Ischemia - diagnosis; Ischemia - etiology; Ischemia - surgery; Leg; Leg - blood supply; Leg - diagnostic imaging; Lysis; Medical diagnosis; Medical imaging; Middle Aged; Pain; Patients; Perfusion; Peripheral embolization; Proteins; Risk analysis; Risk Factors; Selective unilateral antegrade cerebral perfusion; Spectrum analysis; Surgery; Thorax; Thrombectomy; Thrombosis; Thrombosis - complications; Thrombosis - diagnostic imaging; Thrombosis - surgery; Thrombus; Tibial Arteries - diagnostic imaging; Tibial Arteries - surgery; Tomography, X-Ray Computed; Treatment Outcome; Women's health
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-020-01337-2

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. A 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. A 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.