Tratamiento endovascular de trombo flotante sintomático de aorta torácica

Summary. Introduction.Thrombi rarely occur in the thoracic aorta and constitute an important source of embolisms. Endovascular treatment has improved the therapeutic options, which until recently were limited to thromboendarterectomy and/or systemic anticoagulation. Case report. A 52-year-old female smoker, who was referred from another health centre because of diffuse abdominal pain, nausea and vomiting; the findings from a computerised tomography scan of the abdomen showed occlusion of the left common iliac artery, bilateral renal infarction and filling defect in the lower portion of the thoracic aorta. A transthoracic echocardiogram showed a 7 × 23 mm mobile thrombus in the thoracic aorta. Anticoagulation treatment was established in therapeutic doses and magnetic resonance angiography and arteriography were performed. The results of these tests revealed a 3 cm long floating thrombus in the thoracic aorta, which was attached to the atherosclerotic plaque, and occlusion of the left renal and left iliac arteries. Exclusion of the thrombus was performed by deploying a 32 × 112 mm stent (Relay®, Bolton Medical España) in the thoracic aorta, with abdominal aortic access via an 8 mm Dacron graft and a posterior left aortofemoral bypass (common iliac artery < 0.7 cm in diameter). In the intraoperative control arteriography, no leaks or filling defects were observed in images of the thoracic aorta. The post-operative angiotomography confirmed the exclusion of the thrombus. The patient was discharged from hospital with antiplatelet treatment; six months after the operation she remained asymptomatic. Conclusions. The endovascular treatment of these lesions represents a new therapeutic alternative that is safe and effective and which has lower perioperative morbidity and mortality rates. [ANGIOLOGÍA 2008; 60: 347-52]