Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2021; 9(7): 1755-1760
Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1755
Use of three dimensional-printing in the management of floating aortic thrombus due to occult aortic dissection: A case report
Tie-Hao Wang, Ji-Chun Zhao, Fei Xiong, Yi Yang
Tie-Hao Wang, Ji-Chun Zhao, Fei Xiong, Yi Yang, Department of Vascular Surgery, Sichuan University West China Hospital, Chengdu 610000, Sichuan Province, China
Author contributions: Wang TH, Zhao JC and Yang Y performed the surgery and wrote the paper; Wang TH and Xiong F collected the information and followed the patient; Wang TH and Yang Y revised the paper; all authors read and approved the final manuscript.
Supported by Sichuan Foundation of Science and Technology, No. 2019YJ0066; and Sichuan Foundation of Science and Technology, No. 2019YFS0346.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi Yang, MD, Assistant Professor, Department of Vascular Surgery, Sichuan University West China Hospital, No. 37 Guo Xue Xiang, Chengdu 610000, Sichuan Province, China. yangyidoc09@163.com
Received: November 30, 2020
Peer-review started: November 30, 2020
First decision: December 13, 2020
Revised: December 18, 2020
Accepted: December 29, 2020
Article in press: December 29, 2020
Published online: March 6, 2021
Abstract
BACKGROUND

Floating thrombus within the thoracic aorta is a rare entity but may cause systemic embolism. The pathogenesis of floating aortic thrombi is not yet fully understood. No definitive guidelines are available for the management of floating aortic thrombus.

CASE SUMMARY

We report a 48-year-old patient, without a history of trauma and infection, who presented with sudden severe back pain. A floating thrombus within the aortic arch was found by computed tomography angiography (CTA). No evidence of coagulopathies was found. However, with the assistance of a three dimensional-printed model, this floating thrombus was identified to be caused by occult aortic dissection (AD). Subsequently, an emergency thoracic endovascular repair was performed. The patient’s back pain was rapidly alleviated postoperatively. CTA at 1 year showed no filling defect in the stent-graft and aorta.

CONCLUSION

Occult AD is a potential factor causing floating aortic thrombi, endovascular stent-graft exclusion may be an optimal therapeutic choice with promising results. Moreover, the combination of CTA and three dimensional-printed models can contribute to the diagnosis and treatment of floating aortic thrombi due to occult AD.

Keywords: Floating thrombus, Thoracic aorta, Occult aortic dissection, Three dimensional printing, Endovascular treatment, Case report

Core Tip: Floating thrombus within the thoracic aorta is a rare but a life-threatening source of systemic emboli. The pathogenesis of floating aortic thrombi is not yet fully understood. Occult aortic dissection is a potential cause of floating aortic thrombus, which is most commonly detected at autopsy. Misdiagnosis may cause repeated recurrence of floating thrombus. We report a floating aortic thrombus caused by occult aortic dissection identified with the assistance of a three-dimensional printed model. Thoracic endovascular repair was the optimal treatment method in this patient, with promising results. Similar cases have not previously been reported.