Introduction:

acute arterial ischemia is recognized as a life-threatening clinical syndrome related to thrombosis or systemic embolism. The aorta is the source of 5 % of all embolism cases, usually related to atherosclerotic risk factors. Currently, no unified guidelines establish this entity's optimal treatment.

Case presentation:

a 70-year-old male with a smoking history presents to the emergency department complaining of pain, paresthesias, pallor, and coldness in the lower limbs for two months. Acute arterial ischemia is reported, anticoagulation initiated, and thrombolysis of popliteal vessels performed. Subsequently, multiple embolic events develop, and an ulcerated aortic plaque with a large mobile thrombus is reported; hybrid therapy is considered. However, new emboli develop, and the patient dies.

Conclusions:

recognizing the aorta as a potential source of embolism is essential. A judicious diagnostic approach should be performed, and an adequate indication for anticoagulation and appropriate surgical intervention should be established.

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