Endovascular treatment of a mobile thrombus of the thoracic aorta in association with ulcerative colitis.

A 50-year-old woman emergently presented with severe pain of the lower extremities, cold feet, and paresthesia of the toes. Her medical history included inflammatory bowel disease (ulcerative colitis). Clinical examination revealed no femoral, popliteal, or pedal pulses. Duplex ultrasonography revealed no flow in the iliac, femoral, or distal arteries. Bilateral femoral embolectomy was performed, and fresh clots were removed. Transesophageal echocardiography (TEE) showed an echogenic image, 1.8 × 1.7 cm in transverse diameter, with aspects of embolism and with an appendage extending into the descending thoracic aorta (Fig. 1). Chest computed tomography (CT) disclosed a 1.8 × 5.6-cm embolus at the descending aorta, originating near the ostium of the left subclavian artery (Fig. 2). The patient underwent implantation of a Zenith® 28 × 140-mm stent-graft (Cook Medical Inc.; Bloomington, Ind) (Fig. 3). Thirty days later, CT showed proper positioning of the stent-graft and complete exclusion of the thrombus (Fig. 4). Fig. 3 Aortograms show A) the pigtail catheter guidewire and B) the released stent-graft with complete exclusion of the thrombus. Fig. 4 Postoperative computed tomogram shows good positioning of the stent-graft and complete exclusion of the thrombus. Fig. 1 Transesophageal echocardiogram shows a large, mobile thrombus in the thoracic aorta. Fig. 2 Computed tomogram with contrast shows a sub-occlusive thrombus in a transverse section of the descending aorta.