Management of free-floating thrombus in the arch of the aorta in a case of upper limb ischemia

Floating thrombus in a nonaneurysmal and nonatherosclerotic arch of the aorta is an extremely rare event with potential catastrophic complications. There is a risk of both systemic and cerebral embolization. We present a case of floating thrombus in the arch of the aorta who presented with left upper limb advanced ischemia. Confirmation of the diagnosis was done by computed tomography angiogram. His upper limb symptoms were relieved with thrombectomy, supported by medical line of treatment. For floating thrombus in the arch of the aorta, he was started on aggressive anticoagulation therapy, and there was significant resolution after 4 weeks and complete resolution after 3 months of the treatment. We report our experience with a very rare condition and make a proposal for therapeutic interventions.