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Peer-reviewedCC BY 4.0Journal of Investigative Medicine High Impact Case Reports

Concomitant Left Ventricular and Popliteal Thrombectomy With Coronary Artery Bypass Grafting

  • Jeffrey Balian1
  • Dominick D’Antuono2
  • John Conrad3
  • Ali Gheissari2
  • Vahram Ornekian2
  1. 1Center for Advanced Surgical and Interventional Technology, Department of Surgery, University of California, Los Angeles, CA, United States of America
  2. 2Division of Cardiothoracic Surgery, Department of Surgery, Adventist Health Glendale, Los Angeles, CA, United States of America
  3. 3Division of Vascular Surgery, Department of Surgery, Providence Saint Joseph Medical Center, Los Angeles, CA, United States of America
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Abstract

Left ventricular (LV) thrombus in patients with severe coronary artery disease (CAD) poses a difficult decision regarding the safety and timing of revascularization. We report a 61-year-old woman presenting with non-traumatic right ankle pain, a consequence of popliteal artery cardioembolism. Laboratory findings included elevated troponin (549 ng/L), white blood cell count (11.9 k/μL), and hemoglobin A1C (11.5%). Echocardiography revealed distal anteroseptal and apical akinesis with associated LV thrombus, and cardiac catheterization demonstrated underlying multivessel CAD. Given the embolic risk and acute limb malperfusion, LV thrombectomy via apical ventriculotomy, three-vessel coronary bypass, and right popliteal artery thrombectomy with vein patch angioplasty in a single operative setting. The patient recovered without complication and was discharged to a rehabilitation facility on postoperative day six. At three-month follow-up, she remained free of recurrent thromboembolism with normalized LV systolic function and complete resolution of lower extremity symptoms. This case demonstrates the safety of concomitant surgical management of LV thrombus, coronary revascularization, and peripheral thrombectomy in appropriately selected patients, addressing both cardiac and limb ischemia while minimizing embolic risk.

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Cite

BibTeXRIS
BibTeX
@article{balian2026concomitant,
  title = {{Concomitant Left Ventricular and Popliteal Thrombectomy With Coronary Artery Bypass Grafting}},
  author = {Jeffrey Balian and Dominick D’Antuono and John Conrad and Ali Gheissari and Vahram Ornekian},
  journal = {Journal of Investigative Medicine High Impact Case Reports},
  year = {2026},
  month = sep,
  doi = {10.1177/23247096261491190},
  url = {https://doi.org/10.1177/23247096261491190},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Concomitant Left Ventricular and Popliteal Thrombectomy With Coronary Artery Bypass Grafting
AU  - Jeffrey Balian
AU  - Dominick D’Antuono
AU  - John Conrad
AU  - Ali Gheissari
AU  - Vahram Ornekian
PY  - 2026
DA  - 2026/09/16
JO  - Journal of Investigative Medicine High Impact Case Reports
DO  - 10.1177/23247096261491190
UR  - https://doi.org/10.1177/23247096261491190
AB  - Left ventricular (LV) thrombus in patients with severe coronary artery disease (CAD) poses a difficult decision regarding the safety and timing of revascularization. We report a 61-year-old woman presenting with non-traumatic right ankle pain, a consequence of popliteal artery cardioembolism. Laboratory findings included elevated troponin (549 ng/L), white blood cell count (11.9 k/μL), and hemoglobin A1C (11.5%). Echocardiography revealed distal anteroseptal and apical akinesis with associated LV thrombus, and cardiac catheterization demonstrated underlying multivessel CAD. Given the embolic risk and acute limb malperfusion, LV thrombectomy via apical ventriculotomy, three-vessel coronary bypass, and right popliteal artery thrombectomy with vein patch angioplasty in a single operative setting. The patient recovered without complication and was discharged to a rehabilitation facility on postoperative day six. At three-month follow-up, she remained free of recurrent thromboembolism with normalized LV systolic function and complete resolution of lower extremity symptoms. This case demonstrates the safety of concomitant surgical management of LV thrombus, coronary revascularization, and peripheral thrombectomy in appropriately selected patients, addressing both cardiac and limb ischemia while minimizing embolic risk.
SN  - 2324-7096
ER  -