Spontaneous Aortic Arch Thrombus Presenting as Acute Critical Limb Ischemia
We report a case of a 52-year-old male who presented with acute leg ischemia and underwent successful femoral embolectomy and fasciotomies. Investigations revealed a pedunculated mass in the aortic arch, floating under the innominate and left common carotid arteries. Urgent resection was performed t...
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| Veröffentlicht in: | Vascular and endovascular surgery 2010-05, Vol.44 (4), p.309-311 |
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| creator | Adams, Corey Nagpal, A. David Forbes, Thomas L. Lawlor, D. Kirk Chu, Michael W. A. |
| description | We report a case of a 52-year-old male who presented with acute leg ischemia and underwent successful femoral embolectomy and fasciotomies. Investigations revealed a pedunculated mass in the aortic arch, floating under the innominate and left common carotid arteries. Urgent resection was performed through a longitudinal aortotomy with deep hypothermic circulatory arrest and axillary artery perfusion to reveal a 2.5 × 1.5 cm pedunculated mass attached to the posterior aspect of the arch that was resected. Histology revealed thrombus material prompting lifelong systemic anticoagulation. On 3 months follow-up, the patient had returned to normal activities and computed tomography confirmed complete resection without recurrence. This case study demonstrates that spontaneous thrombus formation is possible in high-flow vascular regions such as the aortic arch and also confirms the importance of evaluating central sources of thromboemboli in patients presenting with acute limb ischemia. Urgent surgical removal is recommended and can be performed safely. |
| doi_str_mv | 10.1177/1538574410363620 |
| format | Article |
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David ; Forbes, Thomas L. ; Lawlor, D. Kirk ; Chu, Michael W. A.</creator><creatorcontrib>Adams, Corey ; Nagpal, A. David ; Forbes, Thomas L. ; Lawlor, D. Kirk ; Chu, Michael W. A.</creatorcontrib><description>We report a case of a 52-year-old male who presented with acute leg ischemia and underwent successful femoral embolectomy and fasciotomies. Investigations revealed a pedunculated mass in the aortic arch, floating under the innominate and left common carotid arteries. Urgent resection was performed through a longitudinal aortotomy with deep hypothermic circulatory arrest and axillary artery perfusion to reveal a 2.5 × 1.5 cm pedunculated mass attached to the posterior aspect of the arch that was resected. Histology revealed thrombus material prompting lifelong systemic anticoagulation. On 3 months follow-up, the patient had returned to normal activities and computed tomography confirmed complete resection without recurrence. This case study demonstrates that spontaneous thrombus formation is possible in high-flow vascular regions such as the aortic arch and also confirms the importance of evaluating central sources of thromboemboli in patients presenting with acute limb ischemia. Urgent surgical removal is recommended and can be performed safely.</description><identifier>ISSN: 1538-5744</identifier><identifier>EISSN: 1938-9116</identifier><identifier>DOI: 10.1177/1538574410363620</identifier><identifier>PMID: 20308165</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Acute Disease ; Anticoagulants - therapeutic use ; Aorta, Thoracic - diagnostic imaging ; Aorta, Thoracic - surgery ; Aortic Diseases - complications ; Aortic Diseases - diagnostic imaging ; Aortic Diseases - therapy ; Aortography - methods ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Circulatory Arrest, Deep Hypothermia Induced ; Critical Illness ; Diseases of the aorta ; Embolectomy ; Fasciotomy ; Humans ; Ischemia - diagnostic imaging ; Ischemia - etiology ; Ischemia - therapy ; Lower Extremity - blood supply ; Male ; Medical sciences ; Middle Aged ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Thrombectomy ; Thrombosis - complications ; Thrombosis - diagnostic imaging ; Thrombosis - therapy ; Tomography, X-Ray Computed ; Treatment Outcome ; Vascular surgery: aorta, extremities, vena cava. 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David</creatorcontrib><creatorcontrib>Forbes, Thomas L.</creatorcontrib><creatorcontrib>Lawlor, D. Kirk</creatorcontrib><creatorcontrib>Chu, Michael W. A.</creatorcontrib><title>Spontaneous Aortic Arch Thrombus Presenting as Acute Critical Limb Ischemia</title><title>Vascular and endovascular surgery</title><addtitle>Vasc Endovascular Surg</addtitle><description>We report a case of a 52-year-old male who presented with acute leg ischemia and underwent successful femoral embolectomy and fasciotomies. Investigations revealed a pedunculated mass in the aortic arch, floating under the innominate and left common carotid arteries. Urgent resection was performed through a longitudinal aortotomy with deep hypothermic circulatory arrest and axillary artery perfusion to reveal a 2.5 × 1.5 cm pedunculated mass attached to the posterior aspect of the arch that was resected. Histology revealed thrombus material prompting lifelong systemic anticoagulation. On 3 months follow-up, the patient had returned to normal activities and computed tomography confirmed complete resection without recurrence. This case study demonstrates that spontaneous thrombus formation is possible in high-flow vascular regions such as the aortic arch and also confirms the importance of evaluating central sources of thromboemboli in patients presenting with acute limb ischemia. Urgent surgical removal is recommended and can be performed safely.</description><subject>Acute Disease</subject><subject>Anticoagulants - therapeutic use</subject><subject>Aorta, Thoracic - diagnostic imaging</subject><subject>Aorta, Thoracic - surgery</subject><subject>Aortic Diseases - complications</subject><subject>Aortic Diseases - diagnostic imaging</subject><subject>Aortic Diseases - therapy</subject><subject>Aortography - methods</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Circulatory Arrest, Deep Hypothermia Induced</subject><subject>Critical Illness</subject><subject>Diseases of the aorta</subject><subject>Embolectomy</subject><subject>Fasciotomy</subject><subject>Humans</subject><subject>Ischemia - diagnostic imaging</subject><subject>Ischemia - etiology</subject><subject>Ischemia - therapy</subject><subject>Lower Extremity - blood supply</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Thrombectomy</subject><subject>Thrombosis - complications</subject><subject>Thrombosis - diagnostic imaging</subject><subject>Thrombosis - therapy</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Vascular surgery: aorta, extremities, vena cava. 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A.</creator><general>SAGE Publications</general><general>Sage Publications</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100501</creationdate><title>Spontaneous Aortic Arch Thrombus Presenting as Acute Critical Limb Ischemia</title><author>Adams, Corey ; Nagpal, A. David ; Forbes, Thomas L. ; Lawlor, D. Kirk ; Chu, Michael W. A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c366t-be5c8f449f50f9039a0c08f00bee33f27e7a6c3e6ab55ffa2e74161cb9731baf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Acute Disease</topic><topic>Anticoagulants - therapeutic use</topic><topic>Aorta, Thoracic - diagnostic imaging</topic><topic>Aorta, Thoracic - surgery</topic><topic>Aortic Diseases - complications</topic><topic>Aortic Diseases - diagnostic imaging</topic><topic>Aortic Diseases - therapy</topic><topic>Aortography - methods</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Circulatory Arrest, Deep Hypothermia Induced</topic><topic>Critical Illness</topic><topic>Diseases of the aorta</topic><topic>Embolectomy</topic><topic>Fasciotomy</topic><topic>Humans</topic><topic>Ischemia - diagnostic imaging</topic><topic>Ischemia - etiology</topic><topic>Ischemia - therapy</topic><topic>Lower Extremity - blood supply</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Thrombectomy</topic><topic>Thrombosis - complications</topic><topic>Thrombosis - diagnostic imaging</topic><topic>Thrombosis - therapy</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Adams, Corey</creatorcontrib><creatorcontrib>Nagpal, A. David</creatorcontrib><creatorcontrib>Forbes, Thomas L.</creatorcontrib><creatorcontrib>Lawlor, D. Kirk</creatorcontrib><creatorcontrib>Chu, Michael W. A.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Vascular and endovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Adams, Corey</au><au>Nagpal, A. David</au><au>Forbes, Thomas L.</au><au>Lawlor, D. Kirk</au><au>Chu, Michael W. 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Histology revealed thrombus material prompting lifelong systemic anticoagulation. On 3 months follow-up, the patient had returned to normal activities and computed tomography confirmed complete resection without recurrence. This case study demonstrates that spontaneous thrombus formation is possible in high-flow vascular regions such as the aortic arch and also confirms the importance of evaluating central sources of thromboemboli in patients presenting with acute limb ischemia. Urgent surgical removal is recommended and can be performed safely.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>20308165</pmid><doi>10.1177/1538574410363620</doi><tpages>3</tpages></addata></record> |
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| subjects | Acute Disease Anticoagulants - therapeutic use Aorta, Thoracic - diagnostic imaging Aorta, Thoracic - surgery Aortic Diseases - complications Aortic Diseases - diagnostic imaging Aortic Diseases - therapy Aortography - methods Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Circulatory Arrest, Deep Hypothermia Induced Critical Illness Diseases of the aorta Embolectomy Fasciotomy Humans Ischemia - diagnostic imaging Ischemia - etiology Ischemia - therapy Lower Extremity - blood supply Male Medical sciences Middle Aged Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Thrombectomy Thrombosis - complications Thrombosis - diagnostic imaging Thrombosis - therapy Tomography, X-Ray Computed Treatment Outcome Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels |
| title | Spontaneous Aortic Arch Thrombus Presenting as Acute Critical Limb Ischemia |
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