et al. Pramod Kerkar, M.D., FFARCSI, DA. Therefore, treatment with rivaroxaban was administered for 3 months, and it . Aortic aneurysms that occur in the chest area are called thoracic aortic aneurysms and can involve the aortic root, ascending aorta, aortic arch or descending aorta. Although aortic mural thrombus associated with aortic disease, such as aortic aneurysm and aortic dissection, is often seen, . The 2023 edition of ICD-10-CM I74.11 became effective on October 1, 2022. A 50 years old woman was admitted to the mergency department for pain, coldness, and anesthesia in the the left foot. SVS Member login. (A) The aortic root is visualized with three sinuses of Valsalva and the origin of the right . Open Access | Background Thoracic aortic mural thrombus (TAMT) of the descending aorta is rare but can result in dramatic embolic events. aortic or cardiac diseases, such as aneurysm, penetrating aortic ulcer, severe atherosclerosis, calcication of the thoracic aortic wall, aortic sarcoma, or intracardiac thrombus, were excluded. 116 Hemodynamic characteristics associated with partial thrombosis of the false lumen in patients with chronic aortic dissection of the descending aorta: a 4D flow CMR . Call 434.924.3627. The patients had symptoms of lower limb ischemia; they underwent preoperative angiography and CTscan, then we proceeded with endovascular exclusion of the thrombus from the systemic circulation. Thrombus formation in a morphologically normal aorta, however, is a rare event. Thoracic aortic aneurysm (TAA) is a life-threatening condition that causes significant short- and long-term mortality due to rupture and dissection. Ann Vasc Surg, 36 (2016), pp. She had a 25 years history of cigarette smoking, a history of . Fig. . Signs and symptoms that a thoracic aortic aneurysm has ruptured or dissected include: Sharp, sudden pain in the upper back that spreads downward. Appointments 800.659.7822. In comparison, thrombus formation in a normal-appearing descending thoracic aorta is reported far less often. The descending aorta is part of the main artery in your body. 2019, World Journal of Surgery. However, he refused to undergo surgical excision of the thrombus in the ascending aorta. In comparison, thrombus formation in a normal-appearing descending thoracic aorta is reported far less often. Aneurysms that involve the aorta as it flows through both the abdomen and chest are called thoracoabdominal aortic aneurysms. A case of a descending aortic thrombus incidentally detected on computed tomography scan in a 65-year-old female and successfully treated with anticoagulation, preventing subsequent complications. The patient developed deep venous thrombosis and pulmonary embolism. His repeat aortogram showed near complete recanalisation of descending thoracic aorta. Although they are a rare cause of arterial embolization, this is their main manifestation. Descending thoracic aortic thrombus (DTAT) is a rare entity that can lead to systemic arterial thromboembolism, a serious and potentially life-threatening condition. Continue Reading. Mural thrombus was located in the thoracic aorta in ten patients (52 %) and in the abdominal aorta in nine (48 %) (Verma et al. In addition, yearly composite adverse outcomes . Mural thrombi can arise in normal arteries or within aneurysms. Mural thrombus is usually attributed to systemic hypercoagulability, as summarized in a series of 30 autopsies. A descending thoracic aortic aneurysm can burst . Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Loss of consciousness. The formation of a mural thrombus in descending aorta has not been fully explained; however, the principle of Virchow's triad . Kouchoukos NT, Miller DC, et al. For the thoracic aorta, a diameter greater than 3.5 cm is generally considered dilated, whereas greater than 4.5 cm would be considered . We report the case of a young man with prior history of Buerger's disease and marijuana abuse. In addition, the high force of blood flow in the thoracic aorta requires a longer seal zone (20 mm) on either end to prevent displacement. Although DTAT could be detected incidentally, most cases present with peripheral embolic events, which makes early detection challenging. The overall risk of rupture at 5 years following the initial diagnosis of descending thoracic or thoracoabdominal aortic aneurysm is estimated to be 20% and is dependent on the aortic size at diagnosis: 0% for aneurysms <4 cm diameter, 16% for those 3 to 5.9 cm, and 31% for aneurysms 6 cm or more. Twenty-seven (93.1%) had fully excluded thrombus at the time of the procedure, with no recurrence or evidence of repeated embolic phenomena at follow-up. During his 7 years of follow-up, he has remained asymptomatic from his pulmonary embolism point of view. In general, the term aneurysm is used when the axial diameter is >5.0 cm for the ascending aorta and >4.0 cm for the descending aorta 12.. Damage to the walls of the ascending aorta can lead to a life-threatening condition called a thoracic aortic aneurysm. PROGNOSIS. A Biblioteca Virtual em Sade uma colecao de fontes de informacao cientfica e tcnica em sade organizada e armazenada em formato eletrnico nos pases da Regio Latino-Americana e do Caribe, acessveis de forma universal na Internet de modo compatvel com as bases internacionais. Thoracic aortic aneurysm, without rupture. the artery remains present in the back portion of individual's chest cavity. If the lesion is identified as a thrombus before the operation and is located in the descending aorta, abdominal aorta, or its branches, most surgeons prefer to use anticoagulants [2, 3] and implant an endovascular stent in the descending aorta . Thrombus in the non-aneurysmal, non-atherosclerotic descending thoracic aorta-an unusual source of arterial embolism. Abstract. We describe the case of a 46-year-old woman who had splenic and renal infarctions secondary to embolic showers from a large, mobile thrombus in a morphologically normal proximal descending thoracic aorta. Spontaneous unruptured nondissected aortic aneurysms with intramural thrombus can rarely cause anterior cord infarctions. The presence of thrombi in the atherosclerotic and/or aneurysmatic aorta with peripheral arterial embolism is a common scenario. 1 Therefore, early detection and treatment are critical for a good prognosis. Early treatment is therefore crucial; . . This leakage does not occur due to a tear in the aortic wall and, because of this, the condition has been difficult to diagnose until recently. The stent graft prevents blood flow from entering the aneurysm sac, resulting in aneurysm sac thrombosis and stabilization and/or regression. Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection. Endovascular treatment of symptomatic thrombus of the descending thoracic aorta. Embolism and thrombosis of thoracic aorta. 295.e13-295.e16. Printer-Friendly Version. Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection. Background: A mural thrombus in the descending thoracic aorta frequently leads to distal organ and acute limb ischemia, increasing overall morbidity and mortality. Early diagnosis is imperative as . Thoracic aortic aneurysm (TAA) represents aneurysmal dilatation of the ascending thoracic aorta, the aortic arch, or the descending thoracic aorta, or a combination of these locations.The most common location for TAA is the ascending aorta, followed by the descending aorta. Right atrium (RA) and right ventricle (RV) are dilated with RV hypertrophy ( thin arrow ) and alteration of septal curvature ( arrowhead ). There is dilatation of the main pulmonary artery (MPA) compared with the adjacent ascending aorta (AA), with eccentric thrombus in both right and left pulmonary arteries (thick arrow). Although extremely rare in the descending thoracic aorta, thrombus formation may occur in association with polycythemia vera and should be sought when usual investigations fail to reveal the source. We report a 49-year-old male who presented with chest discomfort for 5&nbsp;days and was admitted to . (1) Aim: The primary endpoint of this study was to evaluate the impact of frozen elephant trunk (FET) and conventional elephant trunk (CET) on aortic mural thrombus. Low blood pressure. Background: A mural thrombus in the descending thoracic aorta frequently leads to distal organ and acute limb ischemia, increasing overall morbidity and mortality.Early diagnosis is imperative as thrombi are usually discovered after end organ damage has taken place. Shortness of breath. We report two cases of descending thoracic aorta floating thrombus treated with Bolton Relay thoracic free-flow stent graft. Causes of mural thrombus. Cleveland Clinic is a non-profit academic medical center. Thirty-two publications Although the condition is similar to, and was once thought to be a type of . Download Free PDF. 2008;85(1 suppl):S1 . The 2022 edition of ICD-10-CM I71.2 became effective on October 1, 2021. The explanted endovascular stent graft demonstrated solid, organized thrombus in the distal portion with less organized thrombotic material proximally (Figure 6 ). Descending thoracic aortic thrombus (DTAT) is a rare entity that can lead to systemic arterial thromboembolism, a serious and potentially life-threatening condition. ABSTRACT Background: A mural thrombus in the descending thoracic aorta frequently leads to distal organ and acute limb ischemia, increasing overall morbidity and mortality. I71.2 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Although DTAT could be detected incidentally, most cases present with peripheral embolic events, which makes early detection challenging . 2 -6 Recent . They are dangerous and can break loose to form emboli. According to this theory, during the sudden deceleration, the distal transverse arch moves forward while the proximal descending thoracic aorta remains stationary, . 2011;41:450-7. Primary thrombosis of the aorta without aneurysm is uncommon. [ 6] Although most thoracic thrombi are seen with atherosclerotic . Early treatment is therefore crucial; however, there is not a consensus on ideal initial treatment. Thoracic aortic mural thrombi are rare in clinical practice, especially in non-aneurysmatic or non-atherosclerotic vessels. Thoracic aortic aneurysms are less common than aneurysms of the abdominal aorta. Background: A mural thrombus in the descending thoracic aorta frequently leads to distal organ and acute limb ischemia, increasing overall morbidity and mortality. The mid-descending thoracic aorta has an average diameter of 2.5 cm (range, 1.6-3.7 cm). Aortic intramural hematoma (IMH) is a condition characterized by blood leaking through the innermost layer of the aortic wall and flowing between the inner and outer walls. 7, 8. Injury of the isthmus portion of the aorta is more common than the involvement of descending aorta in ATAI . Differently, IMH thrombus has a smooth surface, represented by the aortic lamella, and may extend longitudinally. A floating thrombus in the ascending aorta was incidentally discovered in a patient with a descending thoracic aortic aneurysm and a history of alcoholism. Gabriele Piffaretti. 2014). The secondary endpoint was to investigate the incidence of persistent inflammatory response (IR) in the form of post-implantation syndrome (PIS) or persistent fever without infection focus after FET and CET, respectively, as well . Request PDF | Poster No. Difficulty breathing. The term "aneurysm" is used when the axial diameter is >5.0 cm for the ascending aorta and >4.0 cm for the descending aorta . A descending thoracic aortic aneurysm is bulging and weakness in the wall of the descending thoracic aorta, located in the back of the chest cavity. The distal descending thoracic aorta above the diaphragm has an average diameter of 2.4 cm (range, 1.4-3.3 cm). . Thoracic Endovascular Aortic Repair (TEVAR) is performed by placing a covered stent graft into the descending thoracic aorta via transfemoral access. The aorta is the largest blood vessel in the body, and it delivers blood from the heart to the rest of the body. The descending aorta (thoracic aorta) is between the arch of the aorta and the diaphragm muscle below the ribs. No treatment guidelines for an aortic thrombus are currently available. Similar to acute aortic dissection, it is classified as Stanford type A (ascending aorta) or B (exclusive involvement of the descending aorta). As it descends . Article CAS Google Scholar Fayad ZY, Semaan E, Fahoum B, Briggs M, Tortolani A, Ayala M. Aortic mural thrombus in the normal or minimally atherosclerotic aorta. Thrombus has a constant circumferential . Approximately 10% to 30% of patients with acute aortic syndrome have IMH. : Endovascular repair of traumatic thoracic . Use your society credentials to access all journal content and features. When enlarged above normal but not reaching aneurysmal definition, the terms dilatation/ectasia can be used 9,12. . Schedule Online. He presented visceral infarctions due to descending thoracic aortic mobile pedunculated thrombus with complex atherosclerosis. A Case of Thoracic Endovascular Aortic Repair Using Carotid Access with Axillary-Carotid Bypass for Descending Aortic Aneurysm in a Patient with Aortoiliac Occlusive Disease Ann Vasc Dis , 12 ( 1 ) ( 2019 ) , pp. Eur J Vasc Endovasc Surg. Its branches supply blood to your spinal cord, esophagus and other important areas. Society Members, full access to the journal is a member benefit. Descending thoracic aortic thrombus (DTAT) is a rare entity that can lead to systemic arterial thromboembolism, a serious and potentially life-threatening condition.1 Therefore, early detection and treatment are critical for a good prognosis. At the origination point, it is on the left side of the vertebrae. The aorta was replaced with a 20 mm Dacron graft from the distal aortic arch, incorporating the origin of the left subclavian artery, to the mid descending aorta. Therefore the literature is scarce. Anticoagulants include low . Download. We report a case of anterior spinal cord syndrome due to aneurysm of the thoracic aorta with a mural thrombus. It runs through your chest to your diaphragm. The descending thoracic aorta is a part of the aorta located in the thorax.It is a continuation of the aortic arch.It is located within the posterior mediastinal cavity, but frequently bulges into the left pleural cavity.The descending thoracic aorta begins at the lower border of the fourth thoracic vertebra and ends in front of the lower border of the twelfth thoracic vertebra, at the aortic . Introduction. Mural thrombus is basically a blood clot that is formed in the blood and is attached to the lining of a chamber of the heart or the wall of a blood vessel. The curve of the thoracic aorta at the arch presents special challenges in attempting to achieve adequate proximal fixation and seal. The descending thoracic aorta extends from the ligamentum arteriosum to the level of the diaphragmatic hiatus. They can be diagnosed with imaging techniques . A mural thrombus can be symptomatic or asymptomatic; they are mainly formed in the aorta. Early diagnosis is imperative as . The mural thrombus is usually located in the abdominal aorta, but, albeit infrequently, it can occur in the thoracic aorta. At 12 months, the graft . Ann Thorac Surg. They are typically located in the descending aorta, and less frequently in the aortic arch, abdominal aorta, and ascending aorta. IMH and PAU can progress fatally . Cases describing thrombus located in the ascending aorta, abdominal aorta, or aortic arch were also excluded. 105 - 108 , 10.3400/AVD.CR.18-00143 Thoracic aortic thrombus is a rare pathology that usually originates from an atherosclerotic aortic wall lesion or an aortic aneurysm and is a potential source of visceral, cerebral and . La Biblioteca Virtual en Salud es una coleccin de fuentes de informacin cientfica y tcnica en salud organizada y almacenada en formato electrnico en la Regin de Amrica Latina y el Caribe, accesible de forma universal en Internet de modo compatible con las bases internacionales.