Floating Thrombus in the Ascending Aorta Presenting with Recurrent Embolic Events: A Case Report Emphasizing Surgical and Diagnostic Considerations

Background: A floating thrombus in the ascending aorta is a rare but potentially life-threatening condition that may present as cerebral or peripheral arterial embolism. Given the limited number of reports, optimal treatment strategies remain unclear. Case presentation: A 49-year-old male presented with acute right lower extremity ischemia during sleep. Emergent thrombectomy of the right common femoral artery was performed, and subsequent imaging revealed a floating thrombus in the ascending aorta. Notably, the patient had suffered a cryptogenic cerebral infarction two months earlier. Elective ascending aortic replacement was undertaken. The thrombus and affected aortic wall segment were excised and replaced with a prosthetic graft. The patient's postoperative course was uneventful. Conclusions: This case underscores the importance of considering aortic thrombus in patients with recurrent embolic events of undetermined origin. Surgical resection is advisable not only to prevent recurrence but also to exclude malignancy. Detailed intraoperative decision-making regarding perfusion strategy and aortic clamping should be highlighted, especially in rare cases such as this.