Download PDF
Thorac Cardiovasc Surg 2004; 52(3): 187-190
DOI: 10.1055/s-2004-817812
Review

© Georg Thieme Verlag KG Stuttgart · New York

Surgery for Aortic Arch Thrombosis

A. S. Geha1 , C. el-Zein1 , M. G. Massad1 , J. Bagai1 , F. Khoury1 , A. Evans1 , J. Kpodonu1
  • 1Division of Cardiothoracic Surgery, The University of Illinois at Chicago, Chicago, Illinois, USA
Further Information

Publication History

Received: April 22, 2003

Publication Date:
11 June 2004 (online)

    Permissions and Reprints All articles of this category

Abstract

A localized thrombus involving the ascending aorta and arch rarely occurs in the absence of an underlying etiology such as chest trauma, atherosclerosis, a hypercoagulable state or instrumentation. A review of the literature between 1966 - 2003 yielded 38 reported cases of localized aortic arch thrombi, 21 of which were treated by surgical excision of the thrombus using different approaches. In this communication, we describe this clinical entity, with its diagnosis and management. The technical details that are important to ensure the safe conduct of the procedure are discussed.

Key words

Aortic arch thrombosis - thrombectomy - hypothermic circulatory arrest

References

  • 1 Kalangos A, Baldovinos A, Vuille C, Montessuit M, Faidutti B. Floating thrombus in the ascending aorta: A rare cause of peripheral emboli.  J Vasc Surg. 1997;  26 150-154
    PubMedGoogle Scholar
  • 2 Tunick P, Kronzon I. Protruding atherosclerotic plaque in the aortic arch of patients with systemic embolization: A new finding seen by transesophageal echocardiography.  Am Heart J. 1990;  120 658-660
    CrossrefPubMedGoogle Scholar
  • 3 Sprabery T, Newman K, Lohr K. Aortic mural thrombus presenting as pseudovasculitis.  Chest. 1994;  106 282-283
    PubMedGoogle Scholar
  • 4 Laperche T, Laurian C, Roudaut R, Steg G. Mobile thrombus of the aortic arch without aortic debris. A transesophageal echocardiographic finding associated with unexplained arterial embolism.  Circulation. 1997;  96 288-294
    PubMedGoogle Scholar
  • 5 Kolvekar S K, Chaubey S, Firmin R. Floating thrombus in the aorta.  Ann Thorac Surg. 2001;  72 925-927
    CrossrefPubMedGoogle Scholar
  • 6 Moldveen-Geronimus M, Merriam J C. Cholesterol embolization: from pathologic curiosity to clinical entity.  Circulation. 1967;  35 946-953
    PubMedGoogle Scholar
  • 7 Ridker P M, Michel T. Streptokinase therapy in cholesterol embolization.  Am J Med. 1989;  87 357-358
    PubMedGoogle Scholar
  • 8 Culliford A T, Tunick P A, Katz E S, Kronzon I, Galloway A C, Ribakove E S, Esposito R A, Spencer F C. Initial experience with removal of protruding atheroma from aortic arch: diagnosis by transesophageal echo, operative technique and follow-up.  J Am Coll Cardiol. 1993;  21 (Suppl A) 342A-(abstract)
    PubMedGoogle Scholar
  • 9 Roth M, Schonburg M, Kloevekorn W, Bauer E. Thrombotic formations within the aortic arch as source of embolization in patients with coagulopathia.  Eur J Cardio Thorac Surg. 2001;  19 534-536
    PubMedGoogle Scholar
  • 10 Karalis D G, Chandrasekaran K, Victor M F, Ross Jr J J, Mintz G S. Recognition and embolic potential of intraaortic atherosclerotic debris.  J Am Coll Cardiol. 1991;  17 73-78
    PubMedGoogle Scholar
  • 11 Pasierski T, Jasek S, Firek B, Przybylski A, Szwed H, Sadowski Z. Resolution of an aortic mobile mass with anticoagulation without evidence of arterial embolism.  Clin Cardiol. 1996;  19 151-152
    PubMedGoogle Scholar
  • 12 Hassan I, Zehr K, Freeman W. A case of asymptomatic thoracic aorta mural thrombi.  Ann Thorac Surg. 2001;  72 1735-1737
    CrossrefPubMedGoogle Scholar
  • 13 Kalangos A, Vala D, Bednarkiewicz M, Faidutti B. Technical implications regarding surgical removal of a floating thrombus located in the ascending aorta or aortic arch.  Ann Vasc Surg. 1999;  13 115-120
    CrossrefPubMedGoogle Scholar
  • 14 Swanson S J, Cohn L H. Excision of focal aortic arch atheroma using deep hypothermic circulatory arrest.  Ann Thorac Surg. 1995;  60 457-458
    CrossrefPubMedGoogle Scholar
  • 15 Svensson L G, Crawford E S, Hess K R. et al . Deep hypothermia with circulatory arrest: determinants of stroke and early mortality in 656 patients.  J Cardiovasc Surg. 1993;  106 19-32
    PubMedGoogle Scholar
  • 16 Walther T, Mochalski M, Falk V, Mohr F W. Resection of a thrombus floating in the aortic arch.  Ann Thorac Surg. 1996;  62 899-901
    PubMedGoogle Scholar
  • 17 Lukacs L, Lengyel M, Sitkei E, Abermann L. Surgical removal from the descending aorta of a floating thrombus caused by blunt chest trauma.  J Cardiovasc Surg. 1996;  4 846-847
    PubMedGoogle Scholar
  • 18 Morau D, Barthelet Y, Spilmann E, Ryckwaert Y, d'Athis F. Thrombus of the aortic arch: an unusual pathology in intensive care.  Annals Fr Anesthesia et Reanimation. 2000;  19 603-606
    PubMedGoogle Scholar
  • 19 Walther T, Mochalski M, Falk V, Mohr F W. Resection of a thrombus floating in the aortic arch.  Ann Thorac Surg. 1996;  62 899-901
    PubMedGoogle Scholar
  • 20 Sadony V, Waltz M, Lohr E, Rimpel J, Richter H. Unusual cause of recurrent arterial embolism: floating thrombus in the aortic arch surgically removed under hypothermic cardiocirculatory arrest.  Eur J Cardio-thorac Surg. 1988;  2 469-471
    CrossrefPubMedGoogle Scholar
  • 21 Goebel N, Maire R, Streuli R. Flottierende Thromben in der Aorta ascendens.  Vasa. 1983;  12 397-399
    PubMedGoogle Scholar
  • 22 Baumgartner J, Leupi F. Thrombosis of the ascending aorta: a rare cause for recurrent arterial embolism.  Helv Chir Acta (Switzerland). 1993;  60 163-166
    PubMedGoogle Scholar
  • 23 Hanson J A, Lioyd M E, Hughes G R. Aortic root thrombus causing stroke in a patient with systemic lupus erythematosus.  Scand J Rheumatol. 1994;  23 156-158
    PubMedGoogle Scholar

M. D. Malek G. Massad

Division of Cardiothoracic Surgery (MC 958)
The University of Illinois at Chicago

840 South Wood Street, CSB Suite 417

Chicago, Illinois 60612

USA

Phone: + 3129966215

Fax: + 31 29 96 20 13

Email: mmassad@uic.edu

      >