CONTEMPORARY SURGICAL MANAGEMENT OF THORACIC FREE-FLOATING AORTIC THROMBUS.
CCC ePoster Library. LeRoux E. 10/26/19; 280549; 314
Emilie LeRoux
Emilie LeRoux
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Abstract
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BACKGROUND: Free-floating aortic thrombus (FFAT) of the thoracic aorta is rare and clinically challenging. The literature on FFAT is sparse and no clear guidelines are available. The study objectives are to provide insight on the surgical management of FFAT based on the clinical presentation, thrombus characteristics and location and to assess long-term outcome.

METHODS AND RESULTS: A single center retrospective study was conducted between 2004-2019. Seventeen patients (mean age: 52.9 ± 9.1 yo; 58.8% male) with a thoracic FFAT were treated surgically. Clinical presentation was an arterial thromboembolism in 13 (76%) pts and an incidental finding in 4 (24%) pts. Mean thrombus size was 25.3 ± 13.5 mm with attachment site in the ascending aorta in 5 pts, arch in 7 pts and the descending aorta 5 pts. An emergent procedure was required in 30% of cases. Nine patients were treated using cardiopulmonary bypass either through a sternotomy in 8 pts and a thoracotomy in one pt. Circulatory arrest (mean time:12.5±6.0 min) was required in 4 pts. In eight pts the FFAT was 'crushed' to the aortic wall using a thoracic stent-graft (TEVAR); proximal TEVAR landing zone in zone 0 in 2 pts, zone 2 in 2pts and zone 3 in 4 pts. One patient died perioperatively (6%) of ongoing mesenteric ischemia. No patient showed recurrent thromboembolism. One pt required TEVAR explant one month postoperatively for device infection. Five-year survival was 78% with two late non-vascular deaths (lung neoplasia and complication from Crohn disease). A thrombophilia syndrome or neoplasia was diagnosed in 9/17 (52.9%) pre or postoperatively.

CONCLUSION: Thoracic FFAT is rare and can involve any aortic segment. Thrombus size and location are key to establish the operative strategy. TEVAR seems a safe alternative to a standard open surgery in presence of adequate proximal and distal landing sites. Freedom from late FFAT recurrence is excellent regardless of the surgical approach. Postoperative thrombophilia and cancer screening is mandatory.
BACKGROUND: Free-floating aortic thrombus (FFAT) of the thoracic aorta is rare and clinically challenging. The literature on FFAT is sparse and no clear guidelines are available. The study objectives are to provide insight on the surgical management of FFAT based on the clinical presentation, thrombus characteristics and location and to assess long-term outcome.

METHODS AND RESULTS: A single center retrospective study was conducted between 2004-2019. Seventeen patients (mean age: 52.9 ± 9.1 yo; 58.8% male) with a thoracic FFAT were treated surgically. Clinical presentation was an arterial thromboembolism in 13 (76%) pts and an incidental finding in 4 (24%) pts. Mean thrombus size was 25.3 ± 13.5 mm with attachment site in the ascending aorta in 5 pts, arch in 7 pts and the descending aorta 5 pts. An emergent procedure was required in 30% of cases. Nine patients were treated using cardiopulmonary bypass either through a sternotomy in 8 pts and a thoracotomy in one pt. Circulatory arrest (mean time:12.5±6.0 min) was required in 4 pts. In eight pts the FFAT was 'crushed' to the aortic wall using a thoracic stent-graft (TEVAR); proximal TEVAR landing zone in zone 0 in 2 pts, zone 2 in 2pts and zone 3 in 4 pts. One patient died perioperatively (6%) of ongoing mesenteric ischemia. No patient showed recurrent thromboembolism. One pt required TEVAR explant one month postoperatively for device infection. Five-year survival was 78% with two late non-vascular deaths (lung neoplasia and complication from Crohn disease). A thrombophilia syndrome or neoplasia was diagnosed in 9/17 (52.9%) pre or postoperatively.

CONCLUSION: Thoracic FFAT is rare and can involve any aortic segment. Thrombus size and location are key to establish the operative strategy. TEVAR seems a safe alternative to a standard open surgery in presence of adequate proximal and distal landing sites. Freedom from late FFAT recurrence is excellent regardless of the surgical approach. Postoperative thrombophilia and cancer screening is mandatory.
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