A Case of COVID-19-Associated Free-Floating Aortic Thrombus Successfully Treated with Thrombectomy

Abstract

Patient: Male, 61-year-old Final Diagnosis: Aortic thrombosis Symptoms: Shortness of breath Medication:— Clinical Procedure: Thrombectomy Specialty: Infectious Diseases • General and Internal Medicine • Surgery Objective: Unusual clinical course Background: COVID-19 caused by SARS-CoV-2 infection has been associated with a hypercoagulable state in which patients can be at risk for developing venous and arterial thromboembolic events at a rate as high as 31%. A free-floating aortic thrombus (FFT) is a rare life-threatening complication of a hypercoagulable state. These thrombi require medical, endovascular, or surgical treatment. The optimal treatment modality for FFT occurring in the setting of COVID-19 remains unknown. We present a patient with a COVID-19-associated free-floating descending aortic thrombus that was treated with percutaneous vacuum-assisted thrombectomy (angio-VAC). Case Report: A 61-year-old man presented to the hospital with dyspnea and hypoxia and was diagnosed with severe COVID-19 pneumonia. Initial chest computed tomography angiography (CTA) did not show pulmonary emboli or thrombi. Inflammatory markers (D-dimer, lactate dehydrogenase, ferritin, fibrinogen) were tracked every other day. After several measurements of decreasing D-dimer values, there was a noticeable increase in D-dimer level and continued dependence on high levels of supplemental oxygen. A repeat chest CTA showed an FFT, confirmed by transesophageal echocardiogram. Cardiothoracic surgery and interventional radiology teams performed successful angio-VAC percutaneous removal, confirmed with intravascular ultrasound. The patient was subsequently discharged with a 3-month supply of apixaban. Conclusions: Minimally invasive endovascular removal of an FFT is a therapeutic option, as anticoagulation alone carries the risk of partial lysis and repeat embolization. Clinicians can consider this endovascular treatment option paired with therapeutic anticoagulation. Further guidelines on monitoring and treatment of possible COVID-19-associated thrombosis are needed, particularly when the risk of embolization is high.

Coexisting portal vein thrombosis and aortic thrombosis in a patient with COVID-19: A case report and literature review

“…Most of the patients were treated medically using either therapeutic dose of enoxaparin (8 out of 21) or unfractionated heparin (UFH) (8 out of 21), with a resolution of thrombus on repeat imaging, suggesting medical therapy alone to be optimal. However, two patients underwent urgent mechanical thrombectomy in addition to full dose anticoagulation, with significant clinical improvement and favorable outcomes, suggesting need for individualized care based on severity and symptoms [20] , [21] . It is not clear from the current review which patients will benefit from each treatment modality.…”

A rare complication of esophagoplasty in a COVID-19 reconvalescent

“…В пользу тромботических осложнений COVID-19 могут свидетельствовать публикации клинических наблюдений больных, перенесших новую коронавирусную инфекцию с различными тромбоэмболическими и некротическими осложнениями. Интересными представляются серии наблюдений по асептическому некрозу костей крупных суставов [15][16][17], аваскулярный некроз верхней челюсти [18,19], спонтанный некроз пищевода [20], перфорация ободочной кишки [21], некроз тонкой кишки [22,23], острый тромбоз имплантированных стентов [24] и тромбоз аорты [5,[25][26][27].…”

Proof of Concept: Trans-atrial AngioVac Aspiration of Mitral Valve Thrombosis in a COVID-19 Patient

“…First, the impossibility to use standard venous accesses (because of the inadequacy of peripheral vessels or the unusual location of the target mass) could be bypassed by performing direct cannulation of cardiac structures of interest (as in our case) or adopting alternative arterial peripheral accesses. 4 Upgrading the extracorporeal circuit from a venous-venous bypass (as in the standard fashion) to a venous-arterial ECMO-like configuration allows a safe aspiration procedure even in case of hemodynamic compromise of the patient by providing concomitant circulatory support. At the same time, the ECMO circuit requires a lower range of anticoagulation.…”

“…Moreover, a venous-arterial ECMO-like configuration of the extracorporeal circuit might expand the current indications of the device, including hemodynamically unstable patients who may not tolerate a standard venous-venous bypass. Although technically feasible, 1,4,5 larger studies are still needed to prove the efficacy and safety of the AngioVac system in these settings.…”

“…Although technically feasible, 1,4,5 larger studies are still needed to prove the efficacy and safety of the AngioVac system in these settings.…”