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.

Planning for company growth; the executive's guide to effective long range planning.

Mode of access: Internet.

Wildlife and range research needs in northern Mexico and southwestern United States : workshop proceedings, April 20-24, 1981, Rio Rico, Arizona.

"September 1983."

Status and management of neotropical migratory birds : September 21-25, 1992, Estes Park Center, YMCA of the Rockies, Colorado /

Proceedings of a National Training Workshop, Status and Management of Neotropical Migratory Birds, held at the Estes Park Center, YMCA of the Rockies, in Estes Park, Colorado, 21-25 September, 1992.

Riparian management : common threads and shared interests : a western regional conference on river management strategies : February 4-6, 1993, Albuquerque, New Mexico /

Includes bibliographical references.

Proceedings of the Symposium on Research and Management of Annosus Rood Disease (Heterobasidion annosum) in Western North America, April 18-21, 1989, Monterey, California /

Includes bibliographical references.

Proceedings of the Symposium on Fire and Watershed Management, October 26-28, 1988, Sacramento, California /

"March 1989"--T.p. verso.

Range seeding equipment: handbook: description of equipment adapted or designed for use in range seeding and noxious range plant control.

Mode of access: Internet.

Wilderness : effects of designation on economy and grazing in Utah : report to the Honorable Wayne Owens, House of Representatives /

"B-249289"--P. 1.

Rangeland reform '94 : draft environmental impact statement : executive summary /

"This document summarizes the impacts of five management alternatives and seven alternative fee formulas analyzed in the Draft EIS, including a summary of impacts"--Transmittal letter.

Cooperate watershed management research in the lower conifer zone of California /

Mode of access: Internet.

SCOPE 80's : a long-range plan for the EDP community of Illinois State government : update '84.

Previous plan prepared by the SCOPE 80's Task Force.

Strategies for computer-oriented productivity and effectiveness in the 80's : a long-range plan for the EDP community of Illinois state government /

Mode of access: Internet.

Grazing problems in the Southwest and how to meet them /

Includes index.

Conference on Adaptive Ecosystem Restoration and Management--Restoration of Cordilleran Conifer Landscapes of North America : June 6-8, 1996, Flagstaff, Arizona /

"June 1996."