Successful surgical management of a giant floating aortic thrombus causing acute upper limb ischaemia: a case report

Background Aortic thrombi are rare and pose clinical challenges as they often remain undetected until embolic complications occur. Case summary We present the case of a 43-year-old male with acute limb ischaemia, revealed to be due to a large mobile thrombus (measuring 53 × 13 mm) extending from the ascending to descending aorta. The obstruction in the peripheral arteries was managed through mechanical thrombectomy, while the intra-aortic thrombus required surgical intervention. Following these procedures, the patient was put on Apixaban, and no signs of recurrence appeared in subsequent follow-up assessments. Discussion Timely diagnosis of aortic thrombi is essential to prevent embolic events. Large floating thrombi are rare in healthy young individuals with no pre-existing conditions, especially when causing only upper limb ischaemia. Prompt surgical intervention is recommended to treat and prevent recurrence. Conclusion While various strategies exist for dealing with large floating thrombi, prioritizing surgical intervention is essential to prevent potential future recurrences.