Primary Aortic Wall Myxoma Presenting With Recurrent Systemic Embolization: A Hybrid Surgical Management Strategy.
Primary aortic wall myxoma is exceptionally rare and may mimic mural thrombus or acute aortic dissection.
A 38-year-old man presented after approximately 12 hours of acute left lower-limb ischemia with concomitant left upper-limb occlusion. Computed tomography angiography showed filling defects in the ascending and descending thoracic aorta. Recurrent embolization after peripheral thromboembolectomy prompted emergency ascending aortic exploration. A friable intramural myxoma was excised with ascending aortic graft replacement; the descending lesion was excluded by staged thoracic endovascular aortic repair while therapeutic anticoagulation was maintained.
Histopathology confirmed an aortic wall myxoma. The case illustrates the limitations of imaging and an individualized hybrid strategy for suspected multifocal aortic involvement.
Recurrent embolization after embolectomy should prompt urgent proximal-source control. Hybrid repair may be considered when anatomy and clinical urgency support it.
A 38-year-old man presented after approximately 12 hours of acute left lower-limb ischemia with concomitant left upper-limb occlusion. Computed tomography angiography showed filling defects in the ascending and descending thoracic aorta. Recurrent embolization after peripheral thromboembolectomy prompted emergency ascending aortic exploration. A friable intramural myxoma was excised with ascending aortic graft replacement; the descending lesion was excluded by staged thoracic endovascular aortic repair while therapeutic anticoagulation was maintained.
Histopathology confirmed an aortic wall myxoma. The case illustrates the limitations of imaging and an individualized hybrid strategy for suspected multifocal aortic involvement.
Recurrent embolization after embolectomy should prompt urgent proximal-source control. Hybrid repair may be considered when anatomy and clinical urgency support it.
Authors
Ulacia Ulacia, Dalio Dalio, Giuliani Giuliani, Pinto Pinto, Mendes Mendes, Tanure Junior Tanure Junior, Bassetto Bassetto, Durço Durço, Rodrigues Rodrigues, Joviliano Joviliano
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