Floating aortic thrombus: the endovascular approach

Case report : We report a 71-year-old obese white female who presented with sudden right calf pain after-a long distance flight. Symptoms were initially regarded as venous in origin. Duplex investigation ruled out deep vein thrombosis. Ultimately she presented to our department with complaints of claudication. Clinical evaluation and a new duplex scan showed occlusion of the right popliteal artery. Further evaluation with CT-angiography showed, besides occlusion of the right popliteal artery, a floating thrombus in the infrarenal abdominal aorta. The thrombus was treated with a bare-metal stent placed through a femoral approach. CT-scans at 1 and 3 months demonstrated complete exclusion of the thrombus. The claudication of the right calf resolved spontaneously. Floating thrombus of the infrarenal abdominal aorta is a rare cause of distal arterial embolisation. CT-scan with contrast enhancement is the preferred diagnostic technique. Endovascular repair seems to be the treatment of choice and in our opinion a covered stent is not required. Anticoagulation therapy needs to be guided on an individual patient basis.