SURGICAL-TREATMENT OF SYSTEMIC ATHEROEMBOLISM FROM THE THORACIC AORTA

Background. Surgical procedures performed exclusively for atheroemboli c events arising from the thoracic aorta rarely have been reported. Pr esented here are 2 patients who underwent successful operation for the se problems. Methods. The clinical presentation, diagnostic evaluation , and surgical approach to 2 patients with different embolic sources i n the thoracic aorta are presented. One patient had experienced three strokes and was noted by multiplane transesophageal echocardiography t o have protruding atheromas with ulcerations in the transverse arch an d origin of the brachiocephalic vessels. The transverse arch was repla ced using hypothermic circulatory arrest with individual reimplantatio n of the brachiocephalic vessels. The second patient presented with '' blue toe'' syndrome from mobile atheromas in the mid-descending thorac ic aorta defined by transesophageal echocardiography. A localized debr idement was performed using simple aortic cross-clamping. Results. Bot h patients had uneventful postoperative courses and had no further ath eroembolic events. Conclusions. When standard diagnostic modalities do not delineate an embolic source for either stroke or peripheral embol ization, transesophageal echocardiography is recommended as an excelle nt means of identifying atheromas in the thoracic aorta that could be the source for emboli. Once these lesions are identified, a surgical p rocedure should be performed to prevent further embolization.