Surgical Management of Symptomatic Ascending Aortic Mural Thrombus: A Case Report

Ascending aortic mural thrombus (AMT) is a rare but potentially life-threatening source of systemic embolization.We report the case of an 81-year-old woman who presented with acute left upper limb ischemia secondary to embolization from a mobile thrombus involving the ascending aorta and proximal aortic arch.Despite 48 hours of intravenous heparin therapy, repeat imaging demonstrated persistence of the thrombus.The patient underwent thrombectomy with replacement of the ascending aorta and hemiarch.Histopathology demonstrated ulcerated atherosclerotic plaques with associated thrombus.The left upper limb ischemia resolved completely, and the patient was discharged home on postoperative day 8 on oral anticoagulation therapy.At the six-week follow-up visit, she had fully recovered and was living independently.This case highlights the importance of multimodality imaging, operative assessment, and pathological correlation in the management of symptomatic ascending AMT.