Concomitant Left Ventricular and Popliteal Thrombectomy With Coronary Artery Bypass Grafting

Left ventricular (LV) thrombus in patients with severe coronary artery disease (CAD) poses a difficult decision regarding the safety and timing of revascularization. We report a 61-year-old woman presenting with non-traumatic right ankle pain, a consequence of popliteal artery cardioembolism. Laboratory findings included elevated troponin (549 ng/L), white blood cell count (11.9 k/μL), and hemoglobin A1C (11.5%). Echocardiography revealed distal anteroseptal and apical akinesis with associated LV thrombus, and cardiac catheterization demonstrated underlying multivessel CAD. Given the embolic risk and acute limb malperfusion, LV thrombectomy via apical ventriculotomy, three-vessel coronary bypass, and right popliteal artery thrombectomy with vein patch angioplasty in a single operative setting. The patient recovered without complication and was discharged to a rehabilitation facility on postoperative day six. At three-month follow-up, she remained free of recurrent thromboembolism with normalized LV systolic function and complete resolution of lower extremity symptoms. This case demonstrates the safety of concomitant surgical management of LV thrombus, coronary revascularization, and peripheral thrombectomy in appropriately selected patients, addressing both cardiac and limb ischemia while minimizing embolic risk.