Mural Thrombus of the Aorta

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Abstract
Although the association between white thrombus in the aorta and multiple embolic occlusions of peripheral vessels was made 22 yr ago, mural thrombus has been neglected as a major cause of embolus because the process was attributed to paradoxical effects of heparin. Abdominal aortograms demonstrated the presence of large filling defects within the lumen of the aorta in 20 of 39 patients with sudden occlusion of a distal artery. Thirteen patients were not on heparin. These 3.4 .times. 1-2 cm defects were present anywhere from T-10 to the aortic bifurcation and were suprarenal in 10 patients. The 20 patients had 36 separate embolic events, with 5 patients experiencing 7 occlusions of renal or superior mesenteric arteries. Serious medical problems co-existed and all patients had at least 2 of 5 important risk factors (heart disease, recent thrombophlebitis, heparin therapy, abdominal atherosclerosis and postoperative status). Catheter embolectomy alone was associated with recurrent embolization in 4 of 6 patients. Three patients died and 2 required amputation. Of 12 patients treated by embolectomy combined with open aortotomy, recurrent embolization occurred in none, death in 1 and 2 required amputation. All patients with visceral artery occlusions survived with normal function of the previously occluded structure. Wider application of abdominal angiography to treat more appropriately a sizable proportion of patients whose distal emboli originated from large chunks of white thrombus in the abdominal aorta is suggested.