Free-floating thrombus of the aorta: 3 case reports
Abstract Background Idiopathic free-floating thrombus (FFT) of the aorta is a rare occurrence, but it can lead to catastrophic consequences. The initial symptoms are typically cerebral or peripheral embolisms. Surgical thrombectomy and thrombolysis are two primary treatments for FFT. Here, we report...
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Japan Surgical Society
2021-06-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-021-01230-7 |
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| author | Naohiko Oki Yoshito Inoue Sohsyu Kotani |
| author_facet | Naohiko Oki Yoshito Inoue Sohsyu Kotani |
| author_sort | Naohiko Oki |
| collection | DOAJ |
| description | Abstract Background Idiopathic free-floating thrombus (FFT) of the aorta is a rare occurrence, but it can lead to catastrophic consequences. The initial symptoms are typically cerebral or peripheral embolisms. Surgical thrombectomy and thrombolysis are two primary treatments for FFT. Here, we report three cases of patients with idiopathic FFT in the absence of coagulopathy who were treated successfully by surgery with no recurrent thrombi or relapse of symptoms. Case presentation Case 1 involved a 72-year-old male patient with a pedunculated thrombus in the distal aortic arch. Case 2 involved a 62-year-old female patient with a cylinder thrombus in the aortic arch and left common carotid artery. Case 3 involved a 65-year-old male patient with three pedunculated thrombi in the ascending aorta, aortic arch, and left subclavian artery. None of the patients had clinical signs of coagulopathy. Pedunculated or cylinder thrombi have a greater risk of breaking off, which can produce severe peripheral embolism in contrast with intramural thrombi (73% vs. 12%). Due to the high embolism risk for each patient, conservative medical treatment by heparinization was deemed inappropriate, so each patient underwent emergency surgical thrombus removal. After surgery, each of the three patients was treated with warfarin for secondary prevention of thromboembolism. At 7-month follow-up in outpatient practice, a computed tomography (CT) scan indicated that Patient 1 had no recurrent thrombus, and the patient has been symptom-free for 11 months. At 1-month follow-up in outpatient practice, a CT scan indicated that Patient 2 had no recurrent thrombus, and the patient has been symptom-free for 8 years. At 3-week follow-up in hospital, a CT scan indicated that Patient 3 had no recurrent thrombus, but he failed to follow-up after discharge, so his follow-up status is unknown. Conclusions For a large pedunculated or cylinder thrombus located in the thoracic aorta, surgical thrombectomy should be performed. And, in surgical thrombectomy, the location of the cannulas and cross-clamp should be selected carefully according to the location of the thrombus. After surgery, anticoagulant is important to prevent recurrent idiopathic thrombi. |
| format | Article |
| id | doaj-art-4302a1fe2e7443fd8d5d4297c099beb2 |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2021-06-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-4302a1fe2e7443fd8d5d4297c099beb22025-08-20T02:52:45ZengJapan Surgical SocietySurgical Case Reports2198-77932021-06-01711510.1186/s40792-021-01230-7Free-floating thrombus of the aorta: 3 case reportsNaohiko Oki0Yoshito Inoue1Sohsyu Kotani2Department of Cardiovascular Surgery, Hiratsuka City HospitalDepartment of Cardiovascular Surgery, Hiratsuka City HospitalDepartment of Cardiovascular Surgery, Hiratsuka City HospitalAbstract Background Idiopathic free-floating thrombus (FFT) of the aorta is a rare occurrence, but it can lead to catastrophic consequences. The initial symptoms are typically cerebral or peripheral embolisms. Surgical thrombectomy and thrombolysis are two primary treatments for FFT. Here, we report three cases of patients with idiopathic FFT in the absence of coagulopathy who were treated successfully by surgery with no recurrent thrombi or relapse of symptoms. Case presentation Case 1 involved a 72-year-old male patient with a pedunculated thrombus in the distal aortic arch. Case 2 involved a 62-year-old female patient with a cylinder thrombus in the aortic arch and left common carotid artery. Case 3 involved a 65-year-old male patient with three pedunculated thrombi in the ascending aorta, aortic arch, and left subclavian artery. None of the patients had clinical signs of coagulopathy. Pedunculated or cylinder thrombi have a greater risk of breaking off, which can produce severe peripheral embolism in contrast with intramural thrombi (73% vs. 12%). Due to the high embolism risk for each patient, conservative medical treatment by heparinization was deemed inappropriate, so each patient underwent emergency surgical thrombus removal. After surgery, each of the three patients was treated with warfarin for secondary prevention of thromboembolism. At 7-month follow-up in outpatient practice, a computed tomography (CT) scan indicated that Patient 1 had no recurrent thrombus, and the patient has been symptom-free for 11 months. At 1-month follow-up in outpatient practice, a CT scan indicated that Patient 2 had no recurrent thrombus, and the patient has been symptom-free for 8 years. At 3-week follow-up in hospital, a CT scan indicated that Patient 3 had no recurrent thrombus, but he failed to follow-up after discharge, so his follow-up status is unknown. Conclusions For a large pedunculated or cylinder thrombus located in the thoracic aorta, surgical thrombectomy should be performed. And, in surgical thrombectomy, the location of the cannulas and cross-clamp should be selected carefully according to the location of the thrombus. After surgery, anticoagulant is important to prevent recurrent idiopathic thrombi.https://doi.org/10.1186/s40792-021-01230-7ThrombolysisAortaComputed tomography angiographyEmbolic eventsFree-floating thrombiIdiopathy |
| spellingShingle | Naohiko Oki Yoshito Inoue Sohsyu Kotani Free-floating thrombus of the aorta: 3 case reports Surgical Case Reports Thrombolysis Aorta Computed tomography angiography Embolic events Free-floating thrombi Idiopathy |
| title | Free-floating thrombus of the aorta: 3 case reports |
| title_full | Free-floating thrombus of the aorta: 3 case reports |
| title_fullStr | Free-floating thrombus of the aorta: 3 case reports |
| title_full_unstemmed | Free-floating thrombus of the aorta: 3 case reports |
| title_short | Free-floating thrombus of the aorta: 3 case reports |
| title_sort | free floating thrombus of the aorta 3 case reports |
| topic | Thrombolysis Aorta Computed tomography angiography Embolic events Free-floating thrombi Idiopathy |
| url | https://doi.org/10.1186/s40792-021-01230-7 |
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