Key result
IVUS-guided TEVAR with visceral protection successfully excludes large floating aortic thrombus without complications.
Why the study?
Floating thoracic aortic thrombi are rare clinical entities that carry a high risk of systemic embolization.
Case Report (n=1)
No
IVUS-guided thoracic endovascular aortic repair combined with superior mesenteric artery balloon occlusion and bilateral femoral clamping successfully and safely excluded a giant descending thoracic aortic floating thrombus without further embolization.
TEVAR may be feasible for floating thoracic aortic thrombus with embolization; leaves open need for comparative studies before broader adoption.
Floating thoracic aortic thrombus are rare but carry high risk of systemic embolization. We report a 58-year-old hypertensive smoker with one week of abdominal pain. Computed tomography angiography (CTA) revealed a floating thrombus measuring 13 × 3 cm in the descending thoracic aorta, extending up to 1 cm above the celiac trunk, complicated by distal embolization to the celiac trunk and splenic artery resulting in splenic infarction. She underwent thoracic endovascular repair guided by intravascular ultrasound. To prevent further distal embolization, superior mesenteric artery balloon occlusion and bilateral femoral clamping were employed as adjunctive protection strategies. The thrombus was completely excluded without complications; she remained asymptomatic at 14 months of follow-up. IVUS-guided TEVAR with visceral protection is safe and effective for large floating aortic thrombus.
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Morales-Palma et al. (2026) conducted a case report in Giant floating thrombus in the descending thoracic aorta with distal embolization (n=1). Intravascular ultrasound-guided thoracic endovascular repair (TEVAR) with superior mesenteric artery balloon occlusion and bilateral femoral clamping was evaluated on Complete thrombus exclusion and freedom from complications. IVUS-guided TEVAR with visceral protection completely excluded a 13 × 3 cm floating aortic thrombus without complications through 14 months of follow-up.
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