title: Staged endovascular stent grafts for concurrent mobile/ulcerated thrombi of thoracic and abdominal aorta causing recurrent spontaneous distal embolization.
abstract: Mobile thrombus of the thoracic aorta is an uncommon pathology with potentially catastrophic complications. Recurrent spontaneous distal embolization may also occur from an ulcerated thrombus of the abdominal aorta. The simultaneous presence of a mobile thrombus in the thoracic aorta and ulcerated thrombus of the abdominal aorta is extremely rare and poses a significant treatment dilemma. Although various approaches have been reported, there is no standard treatment. Direct replacement of the thoracoabdominal aorta is extremely morbid, while continued embolization despite anticoagulation mandate intervention. We herein present the first case report of successful treatment of symptomatic mobile/ulcerated thrombi of the thoracic and abdominal aorta using staged endovascular stent graft repair. Successful treatment of the thoracic component with a thoracic aortic graft (TAG, Gore-Tex, W. L. Gore & Assoc., Flagstaff, Ariz.) was followed one week later by exclusion of the infrarenal aortic lesion with a bifurcated stent graft. Endovascular stent graft exclusion of mobile/ulcerated thoracic and abdominal aortic thrombi is a minimal invasive operation. It can be employed as an alternative procedure in treatment of aortic thrombus with embolization in high risk patients. Long-term follow-up will be necessary to assess the durability of this technique.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Loma Linda University School of Medicine, 11175 Campus Street, Loma Linda, CA 92350, USA. wwzhang@ahs.llumc.edu
authors.forename: Wayne W
authors.initials: WW
authors.lastname: Zhang
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abou-Zamzam
authors.forename: Mazen
authors.initials: M
authors.lastname: Hashisho
authors.forename: J David
authors.initials: JD
authors.lastname: Killeen
authors.forename: Christian
authors.initials: C
authors.lastname: Bianchi
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Teruya
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000473:pathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery*; D001018:Aortic Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D004617:Embolism / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation; D011474:Prosthesis Design; D012008:Recurrence; D015607:Stents; D013927:Thrombosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014456:Ulcer / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018084:Ultrasonography, Interventional