DIAGNOSIS AND MANAGEMENT OF PATIENTS WITH PERIPHERAL MACROEMBOLI FROMTHORACIC AORTIC PATHOLOGY

Transesophageal echocardiography (TEE) has improved the detection of t horacic aortic pathology and further elucidated its role as a source o f peripheral arterial emboli. Since 1993 we have used TEE to evaluate the thoracic aorta in patients with peripheral emboli without identifi able cardiac sources. Five patients suffered a total of eight embolic events originating from thoracic aortic mural thrombus (TAMT). The fou r females and one male ranged in age from 56 to 82 years. Emboli occur red to the upper extremities in four instances, lower extremities in t hree instances, and the visceral vessels in a single instance. Thrombo embolectomy was performed in each case except for a patient who initia lly underwent aortobifemoral bypass. He was discovered to have TAMT af ter a subsequent embolic event. All patients were anticoagulated after TAMT was identified but in one case anticoagulants were discontinued after an intraabdominal hemorrhage. All patients are alive without lim b loss while one patient has experienced recurrent embolization despit e anticoagulation. TEE is a sensitive and useful diagnostic modality i npatients with ''cryptogenic'' arterial embolization. Whether surgical management or anticoagulation for the primary lesion is optimal thera py remains a question. However, anticoagulation appears effective in t his small experience.