Cor Vasa 2020, 62(6):629-632 | DOI: 10.33678/cor.2020.091

Acute mesenteric ischemia caused by floating thrombus of the descending thoracic aorta - case report

Ernest Biroš, Robert Staffa, Tomáš Novotný, Robert Vlachovský, Miroslav Krejčí

2nd Department of Surgery, Center for Vascular Disease, Faculty of Medicine, Masaryk University and St. Anne's University Hospital, Brno

Introduction: Floating thrombus of the descending thoracic aorta (FTDTA) is defined as the presence of a thrombus inside the thoracic aorta, which is caused by an injury to the thoracic aortic wall (dissection, atherosclerosis, tumour, or trauma) or a thrombophilic state in the absence of a thoracic aortic wall injury. It is a rare condition, but can result in peripheral embolisation mainly into the limbs or visceral circulation. Report: A 63-year-old woman presented with signs of visceral embolisation into the superior mesenteric artery (SMA) and splenic artery (SA). Preoperative CT angiography (CTA) discovered the presence of FTDTA. She underwent emergent open embolectomy of the descending thoracic aorta and SMA done through a visceral segment of the abdominal aorta, reached by left-sided medial visceral rotation. During second-look laparotomy, she underwent splenectomy and ileal resection with end-to-end jejuno-ileal anastomosis. CTA of the thoracic and abdominal aorta performed 12 months after the initial operation showed no residual thrombus inside the aorta and patent peripheral vascular beds. Thirty-two months after the index operation, the patient shows no signs of malabsorption and is in good clinical condition.

Conclusion: Acute mesenteric ischemia resulting from embolisation of FTDTA is a rare disease. Our surgical approach was guided by the primary abdominal symptomatology of our patient and a clinical suspicion of transmural bowel ischemia being present. Our good clinical outcome confirms the viability of the open surgical approach towards the therapy of complicated FTDTA.

Keywords: Abdominal pain, Acute mesenteric ischemia, Descending thoracic aorta, Floating thrombus

Received: April 13, 2020; Revised: July 6, 2020; Accepted: October 10, 2020; Published: December 11, 2020  Show citation