Vascular sequelae of aortic arch thrombo-emboli

An 88-year-old woman presented with thrombo-embolic disease of the left upper extremity manifested by the classical signs of pain, paresthesias, pallor, pulselessness, and poikilothermia. She was found to have a thrombo-embolus in the left distal brachial artery as well as two large thrombi in the aortic arch and proximal descending aorta. Initial surgical intervention included a left upper extremity embolectomy with subsequent restoration of blood flow to the left arm. Due to the patient's advanced age, comorbidities, and availability of medical therapy, it was decided to treat her aortic thrombi through anti-coagulation with coumadin.