Mobile thrombi in the abdominal aorta in cases of extremity embolic arterial occlusion: Value of extended transthoracic echocardiography

Background Lower extremity embolic arterial occlusion is often: associated with proximal atherosclerotic and/or aneurysmal disease.; Fixed atheroscler otic disease of the abdominal aorta has been demonstrated by ultrasonograph y, tomographic studies, and:aortography, but mobile debris has not previous ly been described. We report detection of mobile thrombi in the abdominal a orta during transthoracic echocardiography screening in 6 patients with low er extremity embolic arterial occlusion. Methods Six patients were referred to the echocardiography laboratory for e valuation of a source of peripheral arterial embolism. The transthoracic ec hocardiogram was extended to include longitudinal and transverse images of the abdominal aorta. Additional investigations included abdominal ultrasoun d (6 patients), computed tomography (2 patients), angiography (2 patients), and transesophageal echocardiography (4 patients). Results Six patients (4 men, 2 women, aged 46 to 79 years) presented:with a blue toe syndrome consistent with atheroembolism. During transthoracic ech ocardiography with examination of the abdominal aorta, all were found to ha ve significant atherosclerotic disease of the abdominal aorta with one or m ore mobile components. This finding had a significant impact on treatment o f each patient. Surgical resection of the involved portion of the abdominal aorta in one patient demonstrated an ulcerated atheroma with overlying thr ombus. Conclusion In patients with lower extremity embolic arterial occlusion, eva luation of the abdominal aorta during transthoracic echocardiography should be a routine extension of the echocardiographic examination. The finding o f mobile thrombi in the abdominal aorta identifies a potential source of em bolism for which effective treatment exists.