Ascending aortic replacement successfully treated a free-floating thrombus in the ascending aorta, with no recurrent embolic events or new thrombus formation observed at 5-year follow-up.
Case Report (n=1)
No
Does ascending aortic replacement prevent recurrent systemic embolism in a patient with a free-floating thrombus in the ascending aorta?
Early surgical intervention with graft replacement is a reasonable and effective therapeutic option for preventing recurrent systemic embolism in patients with a free-floating thrombus in the ascending aorta.
BACKGROUND: A free-floating thrombus in the ascending aorta is a rare but clinically significant condition that can cause cerebral and peripheral arterial embolism. Preoperative differentiation from primary aortic tumors, particularly intimal sarcoma, remains challenging even with positron emission tomography-computed tomography (PET-CT). Optimal treatment strategies have not been established. CASE PRESENTATION: A 49-year-old man presented to our emergency department with acute right lower extremity ischemia. Contrast-enhanced computed tomography revealed acute occlusion of the right common femoral artery, and emergent thrombectomy was performed on the same day. He had experienced a cryptogenic cerebral infarction two months earlier; although echocardiography had shown no intracardiac thrombus, he had been managed with anticoagulation alone. To identify the source of recurrent embolism, contrast-enhanced computed tomography from the neck to the pelvis was performed, revealing a pedunculated mass in the ascending aorta. PET-CT showed no abnormal uptake. On hospital day 10, ascending aortic replacement with a prosthetic graft was performed. Intraoperative epi-aortic echocardiography was used to identify the thrombus location and determine a safe cross-clamp site, thereby avoiding deep hypothermic circulatory arrest. The mass was resected together with a ring-shaped segment of the aortic wall at its attachment site to prevent local recurrence. Pathological examination confirmed an organizing thrombus without neoplastic features. The postoperative course was uneventful, and the patient was discharged on postoperative day 13. At 5-year follow-up, no recurrent embolic events or new thrombus formation has been observed. CONCLUSIONS: In patients with a pedunculated free-floating thrombus in the ascending aorta presenting with recurrent systemic embolism, early surgical intervention, including graft replacement, is a reasonable therapeutic option. Graft replacement enables complete excision of the attachment site for recurrence prevention and provides a definitive histopathological diagnosis. However, further accumulation of cases is needed to establish optimal management strategies for this rare condition.
No et al. (Fri,) conducted a case report in Free-floating thrombus in the ascending aorta (n=1). Ascending aortic replacement was evaluated on Recurrent embolic events or new thrombus formation. Ascending aortic replacement successfully treated a free-floating thrombus in the ascending aorta, with no recurrent embolic events or new thrombus formation observed at 5-year follow-up.