Peripheral Vascular Surgery Society

Purpose: The clinical presentation of patients with acute lower limb ischemia and primary aortic thrombus (not clearly defined in the literature) prompted this review.

Methods: Following recognition of the first case in early 1994, relevant patients (n=6) were kept in a database and are reviewed for presentation, treatment, and follow-up.

Results: The median age was 41 and five were male. Angiography, contrast-enhanced computed tomography and/or magnetic resonance angiography demonstrated one or more sessile or pedunculated thrombus(i) without associated atherosclerotic disease. In two cases, a retropancreatic intraaortic mural thrombus was associated with severe pancreatitis: one demonstrated the blue toe syndrome. All other cases presented with acute lower limb emboli requiring limb salvage embolectomy. Abnormal coagulation was generally not found. Extensive thoracoabdominal aortic replacement would have been required to remove all thrombus; therefore, systemic anticoagulation therapy was chosen. Serial studies demonstrated aortic thrombus resolution generally within four months. Failure to continue warfarin therapy resulted in recurrent problems (m=1) unless the instigating event had resolved (n=3). There were no deaths or amputations.

Conclusions: Surgical embolectomy, when required, with subsequent anticoagulation results in limb salvage and allows for eventual resolution of the primary aortic thrombus. Long-term anticoagulation is required, unless a localized process resolves. The literature well describes patients with atherosclerosis and overlying thrombus who require surgical exclusion of the offending plaque to prevent recurrent emboli but fails to describe the approach to patients with primary thrombus formation.