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ISSN: 1734-1922
Archives of Medical Science
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4/2012
vol. 8
 
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Letter to the Editor
Unexplained thrombosis of the aortic arch with distal embolization in a patient with altered fibrin clot properties

Tomasz Ciurus
,
Anetta Undas
,
Malgorzata Lelonek

Arch Med Sci 2012; 8, 4: 733-735
Online publish date: 2012/09/08
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The pathophysiology of arterial thrombosis in young patients remains unclear. Traditional cardiovascular risk factors explain not more than 50% of cases of arterial thrombosis [1]. It is known that arterial inflammation, autoimmune diseases, endothelial dysfunction, atherosclerosis, blood flow abnormalities, and finally, altered platelet function, coagulation or fibrinolysis predispose to arterial thrombosis. The common thrombophilic factors, factor V Leiden and prothrombin G20210A polymorphism, are inconsistently associated with arterial thrombosis [2]. Growing evidence indicates that the structure of a fibrin clot composed of compact thin fibrin networks can predispose to arterial thrombosis [3]. However, a role of abnormal fibrin clot characteristics in arterial thrombosis different from coronary artery thrombosis is unknown. Aortic arch thrombosis (AAT) is a rare pathology and generally is associated with diffuse atherosclerosis of the aortic arch in elderly patients, aortic aneurysm or dissections [4]. However, mobile thrombi in the aortic arch have also been reported in younger patients [5].

We report here a young man who developed unexplained AAT and subsequent emboli to the lower limbs and, importantly, we detected novel prothrombotic fibrin alterations that may be behind this thrombosis.

A 35-year-old man, with no medical history (normal arterial, diabetes mellitus, lipid disorders, no smoking, normal weight) was admitted to the hospital due to paresis of the lower extremities. The patient was paraplegic; femoral and distal pulses were nonpalpable. Computed angiography showed an intraaortic mass which straddled the aortic bifurcation and extended to just below the renal arteries, indicative of a thrombus. Urgent embolectomy and fasciotomy in both lower extremities were performed.

An electrocardiogram showed a regular sinus rhythm at 70 beats/min, with no history of atrial fibrillation. Routine laboratory investigations did not show any abnormalities, with a normal value of blood lipids. C-reactive protein level was 2.82 mg/l and fibrinogen 4.11 g/l. Thrombophilia screening, including prothrombin gene 20210A mutation, factor V Leiden, lupus anticoagulant, antiphospholipid antibodies, protein C, free protein S and antithrombin, yielded negative results.

Interestingly, his mother underwent embolectomy of the aortic arch and brachiocephalic trunk, when she was 42 years.

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