Management of Aortic Thrombus and Associated Embolic Events

Aortic thrombus formation along the vessel wall can precipitate life-threatening systemic embolisation, manifesting as stroke, limb ischaemia or visceral infarction. Predisposing factors range from atherosclerotic plaque disruption, aneurysmal dilatation and hypercoagulable states to inflammatory insults such as uncontrolled hyperglycaemia. Early detection relies on high-resolution imaging modalities including contrast-enhanced computed tomography angiography and transoesophageal echocardiography. Management strategies encompass conservative anticoagulation, surgical thrombectomy with or without aortic reconstruction, and minimally invasive endovascular exclusion. The choice of intervention is guided by thrombus morphology, patient comorbidity and embolic risk. Multidisciplinary heart-team evaluation is pivotal for optimising outcomes, balancing procedural risk against the potential for recurrent embolisation. Emerging evidence supports the safety and efficacy of endovascular stent grafting in selected cases, while novel anticoagulants offer simplified long-term therapy. Nevertheless, uniform guidelines remain elusive, and therapy must be individualised according to thrombus location, attachment characteristics and patient-specific factors.

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Management of Aortic Thrombus and Associated Embolic Events publication trend

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Technical terms

Aortic mural thrombus: A blood clot adherent to the wall of the aorta without associated aneurysm or significant atherosclerosis.

Endovascular stent graft: A fabric-lined metallic scaffold deployed via a catheter to exclude thrombus or aneurysm from the circulation.

Thrombectomy: Surgical removal of a thrombus, often performed via open or minimally invasive techniques to restore vessel patency.

Thoracic endovascular aortic repair (TEVAR): A percutaneous procedure deploying a stent graft to reinforce the thoracic aorta and isolate thrombus.

Systemic embolism: Dislodgement of thrombus fragments leading to occlusion of distant arterial beds such as cerebral, visceral or peripheral vessels.

Direct oral anticoagulant (DOAC): A class of drugs that directly inhibit specific coagulation factors, used for long-term thromboprophylaxis.

References

1. Single-Center Experience with Simultaneous Mural Aortic Thrombosis and Peripheral Obstructive Disease in Pre-COVID-19 and COVID-19 Era. Diagnostics (2023).
2. Endovascular Repair of Primary Thoracic Aortic Mural Thrombus Following Upper Limb Embolization. Brazilian Journal of Cardiovascular Surgery (2021).
3. A Devastating Floating Aortic Thrombus and Ketosis-Prone Diabetes. Cureus (2023).