Management of floating thrombus in the aortic arch

OBJECTIVE Floating aortic thrombus is an underrecognized source of systemic emboli and carries a life-threatening risk of stroke when located in the aortic arch. Optimal treatment is not established in available guidelines. We report our experience in managing floating thrombi in the aortic arch. METHODS Consecutive patients diagnosed with a floating aortic arch thrombus at a tertiary referral center between January 2008 and December 2014 were reviewed. Perioperative and midterm outcomes were assessed. RESULTS Ten patients (8 female) with a median age of 56 years (range, 47-82 years) were identified. Eight patients presented with a symptomatic embolic event, and 2 patients were asymptomatic. One patient presenting with stroke due to embolic occlusion of all supra-aortic vessels died 2 days after admission. Three patients (2 asymptomatic and 1 unfit for surgery) were treated conservatively by anticoagulation, leading to thrombus resolution in 2 patients. In the third patient, the thrombus persisted despite anticoagulation, resulting in recurrent embolic events. The remaining 6 patients underwent open thrombectomy of the aortic arch during deep hypothermic circulatory arrest. All patients treated by surgery had an uneventful postoperative course with no recurrent thrombus or embolic event during follow-up. Median follow-up of all patients was 17 months (range, 11-89 months). CONCLUSIONS Floating aortic arch thrombus is a dangerous source of systemic emboli. Surgical removal of the thrombus is easy to perform and followed by good clinical results. Conservative treatment with anticoagulation may be considered in asymptomatic, inoperable or high-risk patients.

Floating breakwater field experience, West Coast /

Mode of access: Internet.

Field experiences with floating breakwaters in the eastern United States /

In the past 10 years, the use of floating breakwaters as temporary coastal structures has become increasingly widespread in the United States as an inexpensive means for suppressing waves. However, as with any new technology, there have been many failures and a substantial number of imaginative, successful innovations. One of the chief problems contributing to the failure rate has been a lack of awareness by designers of reliable, up-to-date technical information. As part of a large research effort to remedy this problem, a survey was conducted on field experience with floating breakwaters in the Eastern United States. Results of the survey confirmed that state-of-the-art technical literature is not being properly disseminated. Structures built according to early design manuals were shown to have failed before the completion of their design life. Conversely, floating breakwaters built to the standards set by recent research have fared well and show promise of meeting their design golas. The weakest areas of the present technology are flotation and the anchoring systems. It is recommended that a concentrated research effort be directed toward these problem areas; it is also recommended that the monitoring of state-of-the-art projects continue. (Author).

Floating debris control : a literature review /

"June 1987."

Elements of floating-debris control systems /

"September 1988."

Floating tire breakwater tests, Pickering Beach, Delaware /

Mode of access: Internet.

Evaluation of numerical models for a floating breakwater /

"Monitored by Coastal Engineering Research Center, US Army Engineer Waterways Experiment Station."

Monitoring completed coastal projects : operational assessment of floating breakwaters, Puget Sound, Washington /

"April 1988."