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Objective: Intraluminal thrombi within the non-diseased aorta is an uncommon entity with significant potential consequences. Mostly seen in patients with polycythemia vera, malignancy, or underlying coagulopathy, can lead to significant morbidity. Based on location, patients can develop thrombo-embolic events to any organ system, including the GItract, extremities, coronary vessels, and visceral organs. There is inconsistency in the literature regarding the appropriate management of these thrombi. Although it is likely that many of these thrombi continue on without incident, and are never seen, at present, is unclear if those aortic sites with thrombi need to be treated surgically.
Methods: Patients with free intraluminal aortic thrombi for any reason were prospectively studied, at a single tertiary institution over a 12 month period. Aortic aneurysms, aortic injuries or dissections were excluded. All patients were evaluated for possible risk factors, and followed clinically for outcomes. Additionally, those without documented risk factors were fully worked up for underlying malignancy or hypercoagulability disorders. All patients were treated for embolic events with appropriate surgical management, however ALL primary lesions were managed with medical therapy consisting of anticoagulation and serial imaging.
Results: A total of 10 patients (mean age 67, 6M/4F) were included. Of these patients, 7 (70%) had a prior or current malignancy, and 80% of patients had other underlying coagulopathies such as antiphospholipid antibody and myelodysplastic syndromes. 6/10 patients (60%) had embolic events. 5/ 6 patients developed emboli to the lower extremities and underwent surgical embolectomy. The sixth patient underwent a nephrectomy for renal artery embolus. None of these patients, underwent surgical treatment for the primary aortic thrombus. 100% of patients received 81 mg aspirin. 8/10(80%) of patients without contraindications to anticoagulation were additionally placed on either therapeutic lovenox or coumadin. In short term follow up, none of these patients have had further embolic events.
Conclusions: Several risk factors predispose to aortic thrombi. In the present series, 70% had a prior or current malignancy, 80% had associated hypercoagulability disorders and 6o% had embolic manifestations requiring treatment. The primary source of embolism was treated with anti-platelet agents and/or anticoagulation.We believe that early identification, of these thrombi in most situations, and initiation of medical therapy along with surveillance may be effective in the prevention of embolic events.