Acute peripheral ischemia in healthy female patient: an indirect and unanticipated diagnosis of spontaneous thrombus in
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(2020) 15:288
CASE REPORT
Open Access
Acute peripheral ischemia in healthy female patient: an indirect and unanticipated diagnosis of spontaneous thrombus in the aortic arch Laura Rings1* , Igor Schwegler2, Nestoras Papadopoulos1, Achim Häussler1, Dragan Odavic1, Magdalena Schmidt3 and Omer Dzemali1
Abstract Background: In this case we discuss the management of a pediculated floating thrombus in the aortic arch which led to peripheral embolization and acute ischemia oft he left leg. Case presentation: A healthy 46 year old female patient presented with pain in her left leg and progressive numbness. Computed Tomography Angiography (CTA) showed an acute ischemia of the left leg (Rutherford 2 B) with a 2 cm thrombus distal of the aortic bifurcation. Emergency operation with embolectomy, selective thrombembolectomy and patch plasty on the tibioperoneal trunk and local lysis was performed. As part of a further diagnostic examination a thoracic CT scan has been performed revealing a pediculated-floating 2 cm thrombus in the aortic arch. Four days after the initial operation thrombus excision via a minimally invasive access way has been performed. After initiation of the extracorporeal circulation, selective unilateral antegrade cerebral perfusion has been established in mild (30–32 °C) systemic hypothermia. Patients postoperative course was uneventful. Histological evaluation of the mass demonstrated thrombotic material without evidence of infection or malignacy. Conclusion: A pediculated spontaneous thrombus may develop in aortic arch in patients without traditional risk factors or family history of embolic events. Two stage operation was feasible and safe. Keywords: Aortic arch, Thrombus, Peripheral embolization, Selective unilateral antegrade cerebral perfusion
Introduction Peripheral embolization of a thrombus fragment located in the aortic arch is a rare finding in clinical practice. In non-aneurysmal vessels but especially in young patients with no history of atherosclerosis this condition becomes rare. In the current manuscript we aimed to report and discuss the surgical management of a pediculatedfloating 2 cm thrombus in the aortic arch which already * Correspondence: [email protected] 1 Department of Cardiac Surgery, Triemli Hospital Zurich, Birmensdorferstrasse 497, CH-8063 Zürich, Switzerland Full list of author information is available at the end of the article
lead to an acute ischemia of the left leg (Rutherford 2 B). Procedural steps were initiated after interdisciplinary decision making in the Cardio-Vascular-Surgery Team.
Case A 46 year old female patient presented with pain in her left leg and progressive numbness. She has no history of valvular heart disease, atrial fibrillation, hypercoagulable disorder, peripheral vascular disease or claudication. Due to absent pedal pulse an emergency Computed Tomography Angiography (CTA) was initiated with diagnosis of an acute ischemia of the left leg (Rutherford 2 B) with
© The Author(s). 2020 Open Access This article is licensed under a Cre
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