Aortic thrombosis is a rare condition that can be caused by atherosclerosis, aneurysms, thrombophilia, vasculitis, trauma, and malignancy. Symptoms vary based on thrombus size and site of embolization. It can lead to devastating complications including acute limb ischemia, myocardial infarction, stroke, and other target organ ischemia. Diagnosis is based on clinical presentation, imaging findings, and relevant laboratory work-up. Although not well defined, management for aortic thrombosis includes surgical intervention, such as thromboembolectomy, and conservative measures, such as anticoagulation. Here, we present a unique case of aortic thrombosis causing acute lower limb ischemia with elevated lipoprotein(a) and other comorbidities. Based on our literature review, our article is the first to establish the connection between elevated lipoprotein(a) and aortic thrombosis in the nonaneurysmal aorta.
ReberPUPatelAGStaufferEMüllerMFDoDDKniemeyerHW. Mural aortic thrombi: an important cause of peripheral embolization. J Vasc Surg. 1999;30(6):1084–1089.
4.
GagliardiJMBattMKhodjaRHLe basP. Mural thrombus of the aorta. Ann Vasc Surg. 1988;2(3):201–204.
5.
MalyarNMJanosiRABrkovicZErbelR. Large mobile thrombus in non-atherosclerotic thoracic aorta as the source of peripheral arterial embolism. Thromb J. 2005;3:19.
6.
CañadasVVilacostaILuacesM, et al.Thrombosis of an apparently normal thoracic aorta and arterial embolism [in Spanish]. Rev Esp Cardiol. 2008;61(2):196–200.
7.
VaideeswarPDeshpandeJR. Non-atherosclerotic aorto-arterial thrombosis: a study of 30 cases at autopsy. J Postgrad Med. 2001;47(1):8–14.
8.
TsilimparisNHanackUPisimisisGYousefiSWintzerCRückertRI. Thrombus in the non-aneurysmal, non-atherosclerotic descending thoracic aorta--an unusual source of arterial embolism. Eur J Vasc Endovasc Surg. 2011;41(4):450–457.
9.
PagniSTrivediJGanzelBL, et al.Thoracic aortic mobile thrombus: is there a role for early surgical intervention?Ann Thorac Surg. 2011;91(6):1875–1881.
10.
LozanoPGomezFTJuliaJM-RimbauEGarciaF. Recurrent embolism caused by floating thrombus in the thoracic aorta. Ann Vasc Surg. 1998;12(6):609–611.
11.
AgoliniSFShahKTGoodreauJJMcLoughlinTMJrSinclairMC. Splenic infarction caused by a large thoracic aortic thrombus. J Vasc Surg. 1997;26(6):1069–1072.
12.
PrevitaliEBucciarelliPPassamontiSMMartinelliI. Risk factors for venous and arterial thrombosis. Blood Transfus. 2011;9(2):120–138.
13.
MachlederHITakiffHLoisJFHolburtE. Aortic mural thrombus: an occult source of arterial thromboembolism. J Vasc Surg. 1986;4(5):473–478.
14.
PiffarettiGTozziMMariscalcoG, et al.Mobile thrombus of the thoracic aorta: management and treatment review. Vasc Endovascular Surg. 2008;42(5):405–411.
15.
SawadaTShimokawaT. Giant thrombus in the ascending aorta that caused systemic embolism. Interact Cardiovasc Thorac Surg. 2011;12(6):1048–1050.
16.
ParkJSChoiBJShinJH, et al.Pedunculated aortic mural thrombus attached at unusual site of normal aorta presenting with acute myocardial infarction. Can J Cardiol. 2014;30(4):464.e5–e7.
17.
HabibHHsuJWinchellPJDaokoJ. Mural thrombus in the normal-appearing descending thoracic aorta of a chronic smoker. Tex Heart Inst J. 2013;40(5):619–622.
18.
MochizukiYZhangMGolestanehLThananartSCocoM. Acute aortic thrombosis and renal infarction in acute cocaine intoxication: a case report and review of literature. Clin Nephrol. 2003;60(2):130–133.
19.
SharifiMSorkinRLakierJChaitraS. Thoracic aortic thrombosis as a cause of bowel ischemia. A case report. Angiology. 1994;45(11):973–977.
20.
HassanIZehrKJFreemanWK. A case of asymptomatic thoracic aorta mural thrombi. Ann Thorac Surg. 2001;72(5):1735–1737.
21.
EvangelistaAFlachskampfFAErbelR, et al.Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur Heart J. 2010;11(8):645–658.
22.
SpittellPCSewardJBHallettJWJr. Mobile thrombi in the abdominal aorta in cases of lower extremity embolic arterial occlusion: value of extended transthoracic echocardiography. Am Heart J. 2000;139(2 pt 1):241–244.
23.
MirzaIHMitchellARJTimperleyJ. Transoesophageal echocardiography for the identification of a giant aortic thrombus. Heart. 2005;91(6):778.
Van CottEMLaposataMPrinsMH. Laboratory evaluation of hypercoagulability with venous or arterial thrombosis. Arch Pathol Lab Med. 2002;126(11):1281–1295.
26.
FayadZYSemaanEFahoumBBriggsMTortolaniAD’AyalaM. Aortic mural thrombus in the normal or minimally atherosclerotic aorta. Ann Vasc Surg. 2013;27(3):282–290.
27.
MartensTVan HerzeeleIJacobsBDe RyckFRandonCVermassenF. Treatment of symptomatic mobile aortic thrombus. Acta Chir Belg. 2010;110(3):361–364.
SpenceJDKoschinskyM. Mechanisms of lipoprotein(a) pathogenicity: prothrombotic, proatherosclerotic, or both?Arterioscler Thromb Vasc Biol. 2012;32(7):1550–1551.
30.
MaranhãoRCCarvalhoPOStrunzCCPileggiF. Lipoprotein (a): structure, pathophysiology and clinical implications. Arq Bras Cardiol. 2014;103(1):76–84.
31.
LapercheTLaurianCRoudautRStegPG. Mobile thromboses of the aortic arch without aortic debris. A transesophageal echocardiographic finding associated with unexplained arterial embolism. The Filiale Echocardiographie de la Société Française de Cardiologie. Circulation. 1997;96(1):288–294.
32.
Paulin VeraCMMateos ColinACalvo ArrojoGColodro GarcíaJM. Acute aortoiliac thrombosis due to cocaine intake. Ann Vasc Surg. 2013;27(2):239.e1–e4.
WebberJKlineRALucasCE. Aortic thrombosis associated with cocaine use: report of two cases. Ann Vasc Surg. 1999;13(3):302–304.
35.
CreagerMALüscherTFCosentinoFBeckmanJA. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Circulation. 2003;108(12):1527–1532.
36.
BenowitzNLGourlaySG. Cardiovascular toxicity of nicotine: implications for nicotine replacement therapy. J Am Coll Cardiol. 1997;29(7):1422–1431.
37.
PapagrigorakisEIliopoulosDAsimacopoulosPJ, et al.Lipoprotein(a) in plasma, arterial wall, and thrombus from patients with aortic aneurysm. Clin Genet. 1997;52(5):262–271.
