Upper Extremity Ischemia Complicating Ulcerative Plaque in Descending Aorta

Document Type : Case Report


1 Cardiac Surgean, Department of cardiac surgery, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Iran

2 Medical student ,Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran

3 Cardiac Surgeon, Department of cardiac surgery, Hamadan University of Medical Sciences, Iran

4 Cardiac Surgeon, Department of cardiac surgery, Atherosclerosis Prevention Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Iran


A 54-year-old female patient was presented with upper extremity ischemia. Further investigation revealed ulcerated atherosclerosis plaque in aorta with intramural hematoma and clot formation. The subject underwent a successful surgical resection of mass with the assistance of cardiopulmonary bypass and total circulatory arrest.


  1. Kronzon I, Tunick PA. Aortic atherosclerotic disease and stroke. Circulation. 2006; 114:63-75.
  2. Stone DA, Hawke MW, LaMonte M, Kittner SJ, Acosta J, Corretti M, et al. Ulcerated atherosclerotic plaques in the thoracic aorta are associated with cryptogenic stroke: a multiplane transesophageal echocardiographic study. Am Heart J. 1995; 130:105-8.
  3. Harloff A, Simon J, Brendecke S, Assefa D, Helbing T, Frydrychowicz A, et al. Complex plaques in the proximal descending aorta: an underestimated embolic source of stroke. Stroke. 2010; 41:1145-50.
  4. Ganaha F, Miller DC, Sugimoto K, Do YS, Minamiguchi H, Saito H, et al. Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer a clinical and radiological analysis. Circulation. 2002; 106:342-8.
  5. Svensson LG, Crawford ES. Aortic dissection and aortic aneurysm surgery: clinical observations, experimental investigations, and statistical analyses part III. Curr Probl Surg. 1993; 30:1-163.
  6. Ma X, Zhang Z, Fan Z, Zhao L, Yu J. Natural history of spontaneous aortic intramural hematoma progression: six years follow-up with cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2010; 12:27.
  7. Grimm M, Loewe C, Gottardi R, Funovics M, Zimpfer D, Rodler S, et al. Novel insights into the mechanisms and treatment of intramural hematoma affecting the entire thoracic aorta. Ann Thorac Surg. 2008; 86:453-6.
  8. Sueyoshi E, Matsuoka Y, Imada T, Okimoto T, Sakamoto I, Hayashi K. New development of an ulcer-like projection in aortic intramural hematoma: CT evaluation. Radiology. 2002; 224:536-41.
  9. Yoshimura S, Toyoda K, Kuwashiro T, Koga M, Otsubo R, Konaka K, et al. Ulcerated plaques in the aortic arch contribute to symptomatic multiple brain infarction. J Neurol Neurosurg Psychiatry. 2010; 81:1306-11.
  10. Monnin-Bares V, Thony F, Rodiere M, Bach V, Hacini R, Blin D, et al. Endovascular stent-graft management of aortic intramural hematomas. J Vasc Interv Radiol. 2009; 20:713-21.
  11. Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med. 1999; 340:115-26.
  12. Sabetai MM, Conway AM, Hallward G, Bapat V. Ascending aorta thrombus adjacent to a cholesterol-rich plaque as the source of multiple emboli. Interact Cardiovasc Thorac Surg. 2013; 16:389-90.
  13. Sawada T, Shimokawa T. Giant thrombus in the ascending aorta that caused the systemic embolism. Interact Cardiovasc Thorac Surg. 2011; 12:1048-50.
  14. Svensson LG, Kouchoukos NT, Miller DC, Bavaria JE, Coselli JS, Curi MA, et al. Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. Ann Thorac Surg. 2008; 85:S1-41.