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
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Publikationsverlauf

Received: April 22, 2003

Publikationsdatum:
11. Juni 2004 (online)

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.

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
  • 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
  • 3 Sprabery T, Newman K, Lohr K. Aortic mural thrombus presenting as pseudovasculitis.  Chest. 1994;  106 282-283
  • 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
  • 5 Kolvekar S K, Chaubey S, Firmin R. Floating thrombus in the aorta.  Ann Thorac Surg. 2001;  72 925-927
  • 6 Moldveen-Geronimus M, Merriam J C. Cholesterol embolization: from pathologic curiosity to clinical entity.  Circulation. 1967;  35 946-953
  • 7 Ridker P M, Michel T. Streptokinase therapy in cholesterol embolization.  Am J Med. 1989;  87 357-358
  • 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)
  • 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
  • 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
  • 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
  • 12 Hassan I, Zehr K, Freeman W. A case of asymptomatic thoracic aorta mural thrombi.  Ann Thorac Surg. 2001;  72 1735-1737
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 21 Goebel N, Maire R, Streuli R. Flottierende Thromben in der Aorta ascendens.  Vasa. 1983;  12 397-399
  • 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
  • 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

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

Telefon: + 3129966215

Fax: + 31 29 96 20 13

eMail: mmassad@uic.edu