Thrombus in the non-aneurysmal, non-atherosclerotic descending thoracic aorta - An unusual source of arterial embolism

European Journal of Vascular and Endovascular Surgery

Volumn 41, Issue 4, 2011, Pages 450-457

  Tsilimparis, N ^a   Hanack, U ^b   Pisimisis, G ^c   Yousefi, S ^b   Wintzer, C ^a   Ruckert R I ^b  

^a CHARITÉ UNIVERSITÄTSMEDIZIN BERLIN   (Germany)

^b MARTIN LUTHER KRANKENHAUS   (Germany)

^c MICHAEL E DEBAKEY VETERANS AFFAIRS MEDICAL CENTER   (United States)

Author keywords

Embolism; Thoracic aorta; Thrombus

Indexed keywords

ACETYLSALICYLIC ACID; HEPARIN; WARFARIN;

ADULT; AGED; ANTICOAGULANT THERAPY; AORTA THROMBOSIS; AORTOFEMORAL BYPASS; ARTERY EMBOLISM; ARTICLE; ASPERGILLOMA; CLINICAL ARTICLE; COMPUTER ASSISTED TOMOGRAPHY; CONSERVATIVE TREATMENT; CORONARY STENT; DIGITAL SUBTRACTION ANGIOGRAPHY; DISEASE PREDISPOSITION; DRUG EFFICACY; FEMALE; FOLLOW UP; HEPARIN INDUCED THROMBOCYTOPENIA; HUMAN; HYPERHOMOCYSTEINEMIA; MAGNETIC RESONANCE ANGIOGRAPHY; MALE; MEDICAL RECORD; NON ANEURYSMATIC AND NON ATHEROSCLEROTIC DESCENDING THORACIC AORTA; OPEN HEART SURGERY; PRIORITY JOURNAL; PROTEIN C DEFICIENCY; PROTEIN S DEFICIENCY; RECURRENT DISEASE; RENAL ARTERY; RHEUMATIC DISEASE; THROMBECTOMY; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; TREATMENT DURATION; TREATMENT OUTCOME;

AGED; ANGIOGRAPHY, DIGITAL SUBTRACTION; ANTICOAGULANTS; AORTA, THORACIC; AORTIC DISEASES; AORTOGRAPHY; ECHOCARDIOGRAPHY, TRANSESOPHAGEAL; EMBOLISM; ENDOVASCULAR PROCEDURES; FEMALE; GERMANY; HUMANS; MAGNETIC RESONANCE ANGIOGRAPHY; MALE; MIDDLE AGED; RETROSPECTIVE STUDIES; RISK ASSESSMENT; RISK FACTORS; THROMBOSIS; TIME FACTORS; TOMOGRAPHY, X-RAY COMPUTED; TREATMENT OUTCOME; VASCULAR SURGICAL PROCEDURES;

EID: 79953035266     PISSN: 10785884     EISSN: 15322165     Source Type: Journal    
DOI: 10.1016/j.ejvs.2010.11.004     Document Type: Article

References (60)

1. Eliason JL, Wainess RM, Proctor MC, Dimick JB, Cowan Jr JA, Upchurch Jr GR, et al. A national and single institutional experience in the contemporary treatment of acute lower extremity ischaemia. Ann Surg 2003;238:382-9. discussion 9-90.
2. O'Connell JB, Quinones-Baldrich WJ. Proper evaluation and management of acute embolic versus thrombotic limb ischaemia. Semin Vasc Surg 2009;22:10-6.
3. Oliver DO. Embolism from mural thrombus in the thoracic aorta. Br Med J 1967;3:655-6.
4. Crutchfield EH, Katras T, Stanton Jr PE. The descending thoracic aorta as a source of arterial embolic disease: a case report. Am Surg 1998;64:1079-81. (Pubitemid 28484093)
5. Reber PU, Patel AG, Stauffer E, Muller MF, Do DD, Kniemeyer HW. Mural aortic thrombi: an important cause of peripheral embolization. J Vasc Surg 1999;30:1084-9.
6. Hassan I, Zehr KJ, Freeman WK. A case of asymptomatic thoracic aorta mural thrombi. Ann Thorac Surg 2001;72:1735-7.
7. Onwuanyi A, Sachdeva R, Hamirani K, Islam M, Parris R. Multiple aortic thrombi associated with protein C and S deficiency. Mayo Clin Proc 2001;76:319-22. (Pubitemid 32206947)
8. Beldi G, Bissat A, Eugster T, Gurke L, Stierli P, Huber AR. Mural thrombus of the aorta in association with homozygous plasminogen activator inhibitor type 1 (PAI-1)-675(4G) and heterozygous GP Ia 807C/T genotypes. J Vasc Surg 2002;36:632-4.
9. Lau LS, Blanchard DG, Hye RJ. Diagnosis and management of patients with peripheral macroemboli from thoracic aortic pathology. Ann Vasc Surg 1997;11:348-53. (Pubitemid 27295179)
10. Choukroun EM, Labrousse LM, Madonna FP, Deville C. Mobile thrombus of the thoracic aorta: diagnosis and treatment in 9 cases. Ann Vasc Surg 2002;16:714-22. (Pubitemid 41184216)
11. Ruckert RI, Rudolph B, Rogalla P, Walter M. Primary endothelial sarcoma of the thoracic aorta. Vascular 2004;12:140-4. (Pubitemid 38808087)
12. Machleder HI, Takiff H, Lois JF, Holburt E. Aortic mural thrombus: an occult source of arterial thromboembolism. J Vasc Surg 1986;4:473-8. (Pubitemid 17183324)
13. Duda SH, Pusich B, Raygrotzki S, Uckmann FP, Aebert H, Tepe G, et al. Endovascular implantation of stent-grafts in the thoracic aorta -mid-term results of a prospective controlled study. Rofo 2002;174:485-9. (Pubitemid 34492149)
14. Takagi H, Mori Y, Umeda Y, Fukumoto Y, Matsuno Y, Mizuno Y, et al. Surgical treatment of thoracoabdominal aortic mural and floating thrombi extending to infrarenal aorta. J Vasc Surg 2003; 37:1324-7. (Pubitemid 41123114)
15. Slabbekoorn M, Henneman OD, Geelhoed-Duijvestijn PH, Veldkamp RF. Mural aortic thrombus and peripheral embolisation in a patient with hyperhomocysteinaemia. Neth J Med 2006;64:20-2. (Pubitemid 43168898)
16. Prothet J, Floccard B, Levrat A, Guillaume C, Faure A, Marcotte G, et al. Recurrent systemic embolism: look for a thrombus in. the thoracic aorta. Ann Fr Anesth Reanim 2008; 27:723-6.
17. Saratzis N, Melas N, Saratzis A, Lazaridis J, Kiskinis D. Minimally invasive endovascular intervention in emergent and urgent thoracic aortic pathologies: single center experience. Hellenic J Cardiol 2008;49:312-9.
18. Hazirolan T, Perler BA, Bluemke DA. Floating thoracic aortic thrombus in "protein S" deficient patient. J Vasc Surg 2004;40:381.
19. Losanoff JE, Richman BW, Amiridze N, Rider KD, Jones JW. Floating thrombus of the thoracic aorta: a rare consequence of blunt trauma. J Trauma 2004;57:892-4. (Pubitemid 39431219)
20. Bowdish ME, Weaver FA, Liebman HA, Rowe VL, Hood DB. Anticoagulation is an effective treatment for aortic mural thrombi. J Vasc Surg 2002;36:713-9. (Pubitemid 41122966)
21. Cogert G, Siegel RJ. Giant floating aortic thrombus: a rare finding on transesophageal echocardiography. Am J Cardiol 2007;99:739-40.
22. Kloppenburg GT, Sonker U, Schepens MA. Intra-aortic balloon pump related thrombus in the proximal descending thoracic aorta with peripheral emboli. J Invasive Cardiol 2009;21:e110-2.
23. Ryu YG, Chung CH, Choo SJ, Kim YS, Song JK. A case of anti-phospholipid syndrome presenting with a floating thrombus in the ascending aorta. J Thorac Cardiovasc Surg 2009;137:500-2.
24. Rafiq MU, Jajja MM, Qadri SS, Robinson GJ, Cale AR. An unusual presentation of pedunculated thrombus in the distal arch of the aorta after splenectomy for B-cell lymphoma. J Vasc Surg 2008;48:1603-4.
25. Boge G, Gallix B, Gresillon C, Khau Van Kien A, Veerapen R, Quere I. Primary angiosarcoma of the aorta. Vasa 2007;36:33-40. (Pubitemid 46347961)
26. Higgins R, Posner MC, Moosa HH, Staley C, Pataki KI, Mendelow H. Mesenteric infarction secondary to tumor emboli from primary aortic sarcoma. Guidelines for diagnosis and management. Cancer 1991;68:1622-7.
27. Owens CD. JAK2 V617F mutation, mesenteric vein thrombosis, and myeloproliferative disorders. J Vasc Surg 2010;52:205-7.
28. Tunick PA, Culliford AT, Lamparello PJ, Kronzon I. Atheromatosis of the aortic arch as an occult source of multiple systemic emboli. Ann Intern Med 1991;114:391-2.
29. Dougherty MJ, Calligaro KD, Rua I, Delaurentis DA. Idiopathic pedunculated mural thrombus of the nonaneurysmal infrarenal aorta presenting with popliteal embolization: two cases treated with thrombolytic therapy. J Vasc Surg 2000;32:383-7. (Pubitemid 30644953)
30. Hausmann D, Gulba D, Bargheer K, Niedermeyer J, Comess KA, Daniel WG. Successful thrombolysis of an aortic-arch thrombus in a patient after mesenteric embolism. N Engl J Med 1992;327:500-1.
31. Iyer AP, Sadasivan D, Kamal U, Sharma S. Resolution of large intra-aortic thrombus following anticoagulation therapy. Heart Lung Circ 2009;18:49-50.
32. Zhang WW, Abou-Zamzam AM, Hashisho M, Killeen JD, Bianchi C, Teruya TH. Staged endovascular stent grafts for concurrent mobile/ulcerated thrombi of thoracic and abdominal aorta causing recurrent spontaneous distal embolization. J Vasc Surg 2008;47:193-6.
33. Blackshear JL, Jahangir A, Oldenburg WA, RE Safford. Digital embolization fromplaque-related thrombus in the thoracic aorta: identification with transesophageal echocardiography and resolution with warfarin therapy. Mayo Clin Proc 1993;68:268-72. (Pubitemid 23066785)
34. Hahn TL, Dalsing MC, Sawchuk AP, Cikrit DF, Lalka SG. Primary aortic mural thrombus: presentation and treatment. Ann Vasc Surg 1999;13:52-9. (Pubitemid 29048459)
35. Hino H, Terasaki T, Hashimoto Y, Hara Y, Uchino M. Cerebral infarction associated with mobile thoracic ascending aortic thrombus in a patient with essential thrombocythemia. Rinsho Shinkeigaku 1999;39:705-10. (Pubitemid 29507915)
36. Reineke DC, Grapow MT, Schumann M, Seeberger MD, Carrel TP. Massive intraoperative thrombus of the aortic arch and proximal descending aorta. J Card Surg 2009;24:470-2.
37. Altenbernd J, Schurmann K, Walterbusch G. Stent-graft therapy in a mobile thrombus in the thoracic aorta. Rofo 2008;180:158-9. (Pubitemid 351251500)
38. 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;42:781-3. (Pubitemid 41483507)
39. Luebke T, Aleksic M, Brunkwall J. Endovascular therapy of a symptomatic mobile thrombus of the thoracic aorta. Eur J Vasc Endovasc Surg 2008;36:550-2.
40. Piffaretti G, Tozzi M, Caronno R, Castelli P. Endovascular treatment for mobile thrombus of the thoracic aorta. Eur J Cardiothorac Surg 2007;32:664-6. (Pubitemid 47362719)
41. Rancic Z, Pfammatter T, Lachat M, Frauenfelder T, Veith FJ, Mayer D. Floating aortic arch thrombus involving the supraaortic trunks: successful treatment with supra-aortic debranching and antegrade endograft implantation. J Vasc Surg 2009;50:1177-80.
42. Rocco D, Scardia M, Cazzato M, Floris GP, Legittimo A, Scotto di Quacquaro A, et al. Floating thrombus in the thoracic aorta: what should be done? Ital Heart J 2004;5:632-4.
43. Morata Barrado PC, Blanco Canibano E, Garcia Fresnillo B, Guerra Requena M. Acute lower limb ischaemia in a patient with aortic thrombus and essential thrombocytosis. Int J Hematol; 2009.
44. Ulenaers M, Buchel OC, Van Olmen A, Moons V. D'Haens G., Christiaens P. An uncommon cause of visceral arterial embolism in patients presenting with acute abdominal pain: a report of 2 cases. Acta Gastroenterol Belg 2010;73:55-60.
45. Manfredini R, Boari B, Gallerani M. Regarding "Floating thoracic aortic thrombus in 'protein S' deficient patient". J Vasc Surg 2004;40:1062-3. author reply 3.
46. Humbert Jr VH, Tuna IC, Harrison MR, Curtis DB, Webster SA. Aortic tumour in primary anti-phospholipid syndrome. Lancet 2003;361:1676. (Pubitemid 36577439)
47. Messiaen T, Lefebvre C, Lambert M. Case report: thoracic aorta thrombus with systemic embolization: a rare paraneoplastic antiphospholipid syndrome? Am J Med Sci 1996;312:303-5.
48. Antecol DH, Walley VM, Chan KL. Massive acute thrombosis of the descending thoracic aorta in heparin-associated thrombocytopenia and thrombosis. J Am Soc Echocardiogr 1994;7:550-2.
49. Chan SM, Millward SF. Heparin-associated thrombocytopenia with thrombosis presenting as large thrombi in the aorta. AJR Am J Roentgenol 1998;170:354-6. (Pubitemid 28083838)
50. Aggeli C, Barberis VI, Vlachopoulos C, Tsiamis E, Stefanadis C. Acute thoracic aortic thrombosis after intra-aortic balloon pumping. Eur J Echocardiogr 2006;7:175-6. (Pubitemid 43257205)
51. Thalheimer A, Fein M, Geissinger E, Franke S. Intimal angiosarcoma of the aorta: report of a case and review of the literature. J Vasc Surg 2004;40:548-53. (Pubitemid 39165033)
52. Mark HK, Ho NS, Tse CC, Tang LF, Hwang ST. Recurrent lower limb embolism from thoracic aortic mural thrombus: a rare presentation of occult malignancy. Hong Kong Med J 2005;11:503-6.
53. Apiyasawat S, Wongpraparut N, Jacobson L, Berkowitz H, Jacobs LE, Kotler MN. Cisplatin induced localized aortic thrombus. Echocardiography 2003;20:199-200. (Pubitemid 36315616)
54. Yoon S, Schmassmann-Suhijar D, Zuber M, Konietzny P, Schmassmann A. Chemotherapy with bevacizumab, irinotecan, 5-fluorouracil and leucovorin (IFL) associated with a large, embolizing thrombus in the thoracic aorta. Ann Oncol 2006;17:1851-2. (Pubitemid 44884065)
55. Metsvaht T, Hermlin T, Kern H, Kahre T, Starkopf J. Aortic arch thrombosis in a neonate with heterozygous carrier status of factor V Leiden mutation. Congenit Heart Dis 2006;1:40-5.
56. Loffroy R, Boussel L, Farhat F, Douek P. Isolated floating thrombus of thethoracicaorta: a rare sign of traumaticaortic injurymanaged with anticoagulant therapy. Ann Thorac Surg 2007;84:1766. (Pubitemid 47588100)
57. Bosma J, Rijbroek A, Rauwerda JA. A rare case of thromboembolism in a 21-year old female with elevated factor VIII. Eur J Vasc Endovasc Surg 2007;34:592-4. (Pubitemid 47500795)
58. Grothues F, Welte T, Grote HJ, Roessner A, Klein HU. Floating aortic thrombus in systemic aspergillosis and detection by trans-esophageal echocardiography. Crit Care Med 2002;30:2355-8. (Pubitemid 35191590)
59. Sprabery AT, Newman K, Lohr KM. Aortic mural thrombus presenting as pseudovasculitis. Chest 1994;106:282-3. (Pubitemid 24214765)
60. Lozano P, Gomez FT, Julia J, M-Rimbau E, Garcia F. Recurrent embolism caused by floating thrombus in the thoracic aorta. Ann Vasc Surg 1998;12:609-11. (Pubitemid 28522939)