Endovascular Repair of Primary Thoracic Aortic Mural Thrombus Following Upper Limb Embolization

Abstract

We report the case of a 41-year-old female who presented with left upper limb embolization due to primary thoracic aortic mural thrombus; this latter represented an uncommon condition with difficult diagnosis and a high rate of life-threatening complications. Upper extremities embolization is extremely rare because it usually occurs in the lower limbs. Management strategy is still controversial, and no clear guidelines indicate superiority of either conservative or invasive treatment approach to date. Our report illustrates how endovascular exclusion of thoracic aortic mural thrombus has the advantage to be a low-risk procedure that represents a definitive therapy.

Keywords: Aorta, Thoracic, Computed Tomography; Lower Extremity; Thromboembolism; Thrombosis; Upper Extremity.

Fig. 1A

Computed tomography angiography axial scan showing the descending thoracic intraluminal aortic filling defect (red arrow).

Fig. 1B

Volume-rendered two-dimensional imaging showing the left subclavian artery occlusion (yellow arrow) and the primary thoracic aortic mural thrombus (yellow arrowheads).

Fig. 1C

Transesophageal echocardiography showing aortic mural thrombus as pedunculated.

Fig. 1D

Follow-up transesophageal echocardiography showing no modifications of aortic mural thrombus in short axis (left) and long axis (right).

Fig. 2A

Angiogram showing the intra-aortic filling defect (yellow arrow).

Fig. 2B

Angiogram showing graft deployment with descending thoracic aortic thrombus exclusion.

Fig. 2C

Intraoperative transesophageal echocardiography showing complete exclusion of aortic mural thrombus after endograft deployment. Short axis (left) and long axis (right).

Fig. 2D

Volume-rendered three-dimensional follow-up computed tomography angiography imaging showing the endograft deployment in zone 2 and the exclusion of primary thoracic aortic mural thrombus.