A Staged Approach to Aortic Thrombosis with Acute Limb Ischemia
Jessica Williams, MD, Neeta Karani, MD, Collin Gandillon, MD, Mark Mattos, MD, Nitin Malhotra, MD.
Michigan State University/Michigan Vascular Center, Flint, MI, USA.
OBJECTIVE: The purpose of our study is to present a staged approach in the management of a case of aortic thrombosis resulting in bilateral lower extremity acute limb ischemia.
METHODS: Our study a retrospective review of a single case of aortic thrombosis with bilateral lower extremity acute limb ischemia. The patient is a 44 year-old male who presented with several days of acute onset bilateral lower extremity weakness, numbness. Patient had a history of smoking but no history of claudication or rest pain. Doppler exam confirmed diminished ABIs. CTA demonstrated a normal caliber aorta with distal aortic thrombus extending into the bilateral iliac arteries. Patient underwent an angiogram that confirmed the CTA findings. Thus, the patient was taken to the OR for aorta and bilateral iliac artery embolectomies via bilateral groin incisions. The thrombus was sent for pathology and returned as organized thrombus. Post-operatively the patient’s symptoms resolved and he was discharged on anticoagulation. Approximately 3 weeks post-operatively the patient presented to the ED complaining of worsening right great toe dry gangrene. A CTA revealed residual aortic thrombus. Thus, the patient was taken to the OR for a scheduled open aortic thrombectomy. Intra-op the infrarenal aorta was noted to be small and mildly diseased; thus, it was repaired with an aortic tube graft. The patient tolerated the procedure well and was discharged POD#4 on oral anticoagulation.
RESULTS: The patient continues to be free of rest pain and the right great toe dry gangrene has resolved. Thus far, the thromboembolic and hypercoaguable work ups have been negative.
CONCLUSIONS: Aortic thrombosis resulting in acute bilateral lower extremity ischemia is rare. And this incidence is further decreased without aneurysmal or severe aortoiliac occlusive disease. Thus, we present this case to propose that a staged approach to treating this rare entity is safe and effective.
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