Successful surgical management of a giant floating aortic thrombus causing acute upper limb ischaemia: a case report

Background:
Aortic thrombi are rare and pose clinical challenges as they often remain undetected until embolic complications occur.

Case summary:
We present the case of a 43-year-old male with acute limb ischaemia, revealed to be due to a large mobile thrombus (measuring 53 × 13 mm) extending from the ascending to descending aorta. The obstruction in the peripheral arteries was managed through mechanical thrombectomy, while the intra-aortic thrombus required surgical intervention. Following these procedures, the patient was put on Apixaban, and no signs of recurrence appeared in subsequent follow-up assessments.

Discussion:
Timely diagnosis of aortic thrombi is essential to prevent embolic events. Large floating thrombi are rare in healthy young individuals with no pre-existing conditions, especially when causing only upper limb ischaemia. Prompt surgical intervention is recommended to treat and prevent recurrence.

Conclusion:
While various strategies exist for dealing with large floating thrombi, prioritizing surgical intervention is essential to prevent potential future recurrences.