False lumen thrombus following aortic dissection diagnosed as the source of repeat lower extremity emboli with angioscopy: a case report
Abstract Background Acute arterial embolization caused by a free-floating thrombus of the false lumen after surgery for acute aortic dissection is a rare complication; hence, determining its cause may be difficult. We report a case in which angioscopy was valuable in diagnosing and treating the unst...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-04-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-022-01416-7 |
| _version_ | 1818273424531783680 |
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| author | Riha Shimizu Makoto Sumi Yuri Murakami Takao Ohki |
| author_facet | Riha Shimizu Makoto Sumi Yuri Murakami Takao Ohki |
| author_sort | Riha Shimizu |
| collection | DOAJ |
| description | Abstract Background Acute arterial embolization caused by a free-floating thrombus of the false lumen after surgery for acute aortic dissection is a rare complication; hence, determining its cause may be difficult. We report a case in which angioscopy was valuable in diagnosing and treating the unstable thrombus within the false lumen. Case presentation The patient was a 71-year-old woman who underwent hemiarch replacement for Stanford type A acute aortic dissection. Two months after the operation, left renal infarction occurred. Eighteen months after the operation, the patient visited the hospital for treatment of intermittent claudication of her left leg. Computed tomography (CT) showed occlusion below the left common femoral artery. Surgical thrombectomy was performed for acute lower extremity arterial occlusion. One month later, thrombectomy was performed again for the same phenomenon and again after 2 months. She had no history of cardiac arrhythmia. No obvious source for the repeat embolization could be found on echocardiography or enhanced CT. Angiography was performed to further identify the cause, revealing a new entry site at the distal anastomosis, which exhibited antegrade flow into the false lumen. Furthermore, selective false lumen angiography via the re-entry revealed a thrombus in the false lumen corresponding to the descending aorta. A non-obstructive angioscopy system in the false lumen revealed a free-floating thrombus. As the patient had undergone multiple surgeries over a short period and desired minimally invasive treatment, coil embolization of the new entry site as well as false lumen was performed. As a result, blood flow from the true to the false lumen resolved. More than 1 year has passed following coil embolization with no signs of embolism. Conclusions We experienced a case of repeat embolism caused by unstable thrombus formation in the false lumen resulting from antegrade blood flow in the false lumen secondary to development of a new entry site. Angioscopy revealed that this antegrade flow caused formation of an unstable thrombus which caused recurrent acute lower extremity arterial occlusion. Therefore, angioscopy may be a useful option for the diagnosis of false lumen thrombosis. |
| first_indexed | 2024-12-12T21:57:45Z |
| format | Article |
| id | doaj.art-ae0164f321234e71b2c64caf345fcb81 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-12-12T21:57:45Z |
| publishDate | 2022-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-ae0164f321234e71b2c64caf345fcb812022-12-22T00:10:35ZengSpringerOpenSurgical Case Reports2198-77932022-04-01811610.1186/s40792-022-01416-7False lumen thrombus following aortic dissection diagnosed as the source of repeat lower extremity emboli with angioscopy: a case reportRiha Shimizu0Makoto Sumi1Yuri Murakami2Takao Ohki3Department of Vascular Surgery, Saitama Prefectural Cardiovascular and Respiratory CenterDepartment of Vascular Surgery, Saitama Prefectural Cardiovascular and Respiratory CenterDepartment of Vascular Surgery, Saitama Prefectural Cardiovascular and Respiratory CenterDivision of Vascular Surgery, Department of Surgery, The Jikei University School of MedicineAbstract Background Acute arterial embolization caused by a free-floating thrombus of the false lumen after surgery for acute aortic dissection is a rare complication; hence, determining its cause may be difficult. We report a case in which angioscopy was valuable in diagnosing and treating the unstable thrombus within the false lumen. Case presentation The patient was a 71-year-old woman who underwent hemiarch replacement for Stanford type A acute aortic dissection. Two months after the operation, left renal infarction occurred. Eighteen months after the operation, the patient visited the hospital for treatment of intermittent claudication of her left leg. Computed tomography (CT) showed occlusion below the left common femoral artery. Surgical thrombectomy was performed for acute lower extremity arterial occlusion. One month later, thrombectomy was performed again for the same phenomenon and again after 2 months. She had no history of cardiac arrhythmia. No obvious source for the repeat embolization could be found on echocardiography or enhanced CT. Angiography was performed to further identify the cause, revealing a new entry site at the distal anastomosis, which exhibited antegrade flow into the false lumen. Furthermore, selective false lumen angiography via the re-entry revealed a thrombus in the false lumen corresponding to the descending aorta. A non-obstructive angioscopy system in the false lumen revealed a free-floating thrombus. As the patient had undergone multiple surgeries over a short period and desired minimally invasive treatment, coil embolization of the new entry site as well as false lumen was performed. As a result, blood flow from the true to the false lumen resolved. More than 1 year has passed following coil embolization with no signs of embolism. Conclusions We experienced a case of repeat embolism caused by unstable thrombus formation in the false lumen resulting from antegrade blood flow in the false lumen secondary to development of a new entry site. Angioscopy revealed that this antegrade flow caused formation of an unstable thrombus which caused recurrent acute lower extremity arterial occlusion. Therefore, angioscopy may be a useful option for the diagnosis of false lumen thrombosis.https://doi.org/10.1186/s40792-022-01416-7Chronic aortic dissectionAcute lower extremity arterial occlusionNon-obstructive angioscopyCoil embolization |
| spellingShingle | Riha Shimizu Makoto Sumi Yuri Murakami Takao Ohki False lumen thrombus following aortic dissection diagnosed as the source of repeat lower extremity emboli with angioscopy: a case report Surgical Case Reports Chronic aortic dissection Acute lower extremity arterial occlusion Non-obstructive angioscopy Coil embolization |
| title | False lumen thrombus following aortic dissection diagnosed as the source of repeat lower extremity emboli with angioscopy: a case report |
| title_full | False lumen thrombus following aortic dissection diagnosed as the source of repeat lower extremity emboli with angioscopy: a case report |
| title_fullStr | False lumen thrombus following aortic dissection diagnosed as the source of repeat lower extremity emboli with angioscopy: a case report |
| title_full_unstemmed | False lumen thrombus following aortic dissection diagnosed as the source of repeat lower extremity emboli with angioscopy: a case report |
| title_short | False lumen thrombus following aortic dissection diagnosed as the source of repeat lower extremity emboli with angioscopy: a case report |
| title_sort | false lumen thrombus following aortic dissection diagnosed as the source of repeat lower extremity emboli with angioscopy a case report |
| topic | Chronic aortic dissection Acute lower extremity arterial occlusion Non-obstructive angioscopy Coil embolization |
| url | https://doi.org/10.1186/s40792-022-01416-7 |
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