title: Thoracic aortic mobile thrombus: is there a role for early surgical intervention?
abstract: BACKGROUND
  The diagnosis of thoracic aortic mobile thrombus (TAMT) is rare and is usually made after debilitating embolic events. The optimal treatment strategy is unknown. We report 14 patients with TAMT and aim to better define the role of early (less than 2 weeks) surgical thrombectomy.
  
  
  METHODS
  Between February 1996 and February 2010, we treated 14 patients (9 women; aged 32 to 84 years, mean age 51 years) with TAMT. Hypercoagulable disorders or a strong family history of vascular thrombosis, or both, occurred in 9 patients. Diagnosis was made by transesophageal echocardiogram in 6, computed tomography angiography in 7, and digital subtraction angiography in 1. Embolic locations were extremities (n=9), cerebral (n=6), and abdominal (n=6). Aortic thrombi (n=17) locations were ascending/arch (n=7), descending (n=8), and thoracoabdominal (n=2).
  
  
  RESULTS
  All patients were initially treated with heparin and aspirin. Thoracic aortic thrombectomies were performed in 8 patients within 2 weeks of diagnosis: left thoracotomy (n=5), thoracoabdominal (n=1), and median sternotomy (n=2). Left atrial-femoral bypass was used in 5 patients, cardiopulmonary bypass in 2, and no support in 1. Additional procedures were celiac artery (n=1) and left subclavian artery (n=2) thrombectomies. Procedures for embolic complications were performed in 7 patients before aortic thrombectomy. Operative mortality was 0%, with no recurrent embolic events after 24±16 months. One patient had thrombectomy of the ascending aorta and medical therapy with warfarin and aspirin for a second concurrent small thrombus in the descending aorta. One patient presented with multiorgan failure and died shortly after admission. Six patients treated medically were discharged on a regimen of oral warfarin and aspirin (14±11 months follow-up), with 2 fatal recurrent embolic events within 6 weeks (p=0.09).
  
  
  CONCLUSIONS
  Thoracic aortic mobile thrombus is rare and is commonly associated with morbid thromboembolic events. In our experience, early surgical aortic thrombectomy had a low operative risk and may prevent fatal recurrent embolic events.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky 40202, USA. spagni@louisvilleheartsurgery.com
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pagni
authors.forename: Jaimin
authors.initials: J
authors.lastname: Trivedi
authors.forename: Brian L
authors.initials: BL
authors.lastname: Ganzel
authors.forename: Matthew
authors.initials: M
authors.lastname: Williams
authors.forename: Nick
authors.initials: N
authors.lastname: Kapoor
authors.forename: Charles
authors.initials: C
authors.lastname: Ross
authors.forename: A David
authors.initials: AD
authors.lastname: Slater
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000601:surgery*; D001241:Aspirin / Q000627:therapeutic use; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed
chemical_list: D001241:Aspirin