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Case Reports
. 2026 Feb;33(1):510-513.
doi: 10.1177/15266028241256817. Epub 2024 May 30.

A Free-Floating Aortic Thrombus: An Uncommon Approach to Handle a Rare Clinical Entity

Kristina Grassl  1 , Herbert Hangler  2 , Alexandra Gratl  1 , Florian Enzmann  1 , Michael Grimm  2 , Josef Klocker  1 , Sabine Wipper  1
Affiliations
Case Reports

A Free-Floating Aortic Thrombus: An Uncommon Approach to Handle a Rare Clinical Entity

Kristina Grassl et al. J Endovasc Ther. 2026 Feb.

Abstract

Background: Thrombotic material in the non-aneurysmatic and non-atherosclerotic aorta is a rare entity without any recommended standard treatment so far. We present a successful treatment strategy for patients who do not fit into any of the common approaches.

Case report: A free-floating thrombus in the descending aorta was found as source of embolism in an 82-year-old female patient with lower limb ischemia. After initial heparinization of the patient without relevant reduction of the thrombotic mass, the thrombus was removed using an interdisciplinary approach. Under echocardiographic guidance to locate the thrombus, the AngioVac device, usually licensed to remove floating thrombi from the venous system, was used off-label to remove the thrombus by a transfemoral approach. To avoid rebuilding of a new thrombus, the attachment point with an exulcerated plaque in the descending aorta was covered by a stent graft via the same femoral access. The patient did not experience any further embolic events, and the postoperative course was uncomplicated.

Conclusion: Patients with uncommon aortic diseases, such as the reported free-floating thrombus, should be treated by an individualized, interdisciplinary approach. Besides the recommended treatment options, there are other uncommon approaches that might offer an alternative in complex cases.Clinical ImpactEvidence is rare for the treatment of a free-floating thrombus in the descending aorta and the treatment strategy remains discussed controversially. We present a rather uncommon approach of successful off-label treatment for patients who do not fit into any of the common approaches (operative, endovascular, or conservative treatment based on patient's comorbidities). The AngioVac System has already been successfully used off-label in the arterial system but not in the above presented way of treating a free-floating thrombus in a patient with high embolization risk and treatment-limiting comorbidities.

Keywords: AngioVac; acute limb ischemia; descending thoracic aorta; free-floating thrombus; stent graft.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The free-floating thrombus in the descending aorta in the preoperative CT-scan (1) and after removal in the AngioVac System (2).
See this image and copyright information in PMC

References

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