A Case of Endoscopic-Assisted Thrombectomy of the Descending Aorta through a Small Left Intercostal Thoracotomy

Takahiro Tashima＊	Hidenori Sako＊	Tetsushi Takayama＊
Keitaro Okamoto＊	Kaoru Uchida＊	Shinji Miyamoto＊＊

（Department of Cardiovascular Surgery, Oita Oka Hospital＊, Oita, Japan, and Department of Cardiovascular Surgery, Faculty of Medicine, Oita University＊＊, Yufu, Japan）

A 64-year-old man had severe pain and became paralyzed in the right lower limb. He was diagnosed with acute arterial occlusion of his right lower limb and was referred to our hospital. Enhanced computed tomography revealed occlusion of the popliteal artery and lower limb arteries and a filling defect in the proximal descending aorta. Although an electrocardiogram demonstrated atrial fibrillation, blood tests did not reveal any underlying disease that could have led to coagulation abnormalities. To prevent recurrent embolism, an approximately 10 cm long skin incision was made at the fifth intercostal space, and endoscopic-assisted thrombectomy of the proximal descending aorta was performed under femoral-femoral bypass（F-F bypass). Histologically, the mass was a blood clot, and atheromatous degeneration was detected in the resected aortic wall. The postoperative course was good and the patient was discharged after construction of an artificial limb. Direct oral anticoagulant（apixaban）and an antiplatelet medication（aspirin）were prescribed, and no recurrence of thrombosis was observed in over two years.

 

Jpn. J. Cardiovasc. Surg. 50:401-404（2021）

Keywords：thrombectomy;descending aorta;endoscopic assistance;minimally-invasive