Aortic Thrombosis in the Course of Covid-19 Disease; Two Rare Cases

Çora, Ahmet Rıfkı; Çelik, Ersin; Karadem, Kadir Burhan

doi:10.1016/j.avsg.2021.02.007

Cited by 10 publications

(7 citation statements)

References 11 publications

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“…Importantly, our case demonstrated that the functional asplenia may persist even months after the acute phase of splenic infarct highlighting the need for continuous antibiotic treatment, correct administration of vaccines and vigilance for potential infections. Aortic thrombosis, another complication rarely seen in the acute COVID-19 sequelae [ 7 , 19 , 20 ] was also reported at our patient and was attributed to severe COVID-19 pneumonia inducing prothrombotic state through one of the aforementioned mechanisms. Notably, antiphospholipid antibodies frequently seen in other cases with arterial thrombotic complications were not detected in our patient, nor were anticardiolipin antibodies that could partially explain the acquired coagulopathy in this patient [ 21 , 22 ].…”

Section: Discussionsupporting

confidence: 65%

A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

et al. 2022

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a high incidence of arterial and venous thrombotic complications. However, thromboembolic events in unusual sites such as limb and visceral arterial ischemia are reported rarely in the literature. Herein, we describe a rare case of a patient with severe coronavirus disease 2019 (COVID-19) infection who experienced severe abdominal pain during the hospitalization and presented simultaneously renal artery, splenic artery and vein as well as aortic thrombi despite prophylactic antithrombotic treatment. Information about his follow-up post discharge is also provided. This case report raises significant clinical implications regarding the correct dose of antithrombotic treatment during the acute phase of the severe COVID-19 infection and highlights the need for incessant vigilance in order to detect thrombosis at unusual sites as a possible diagnosis when severe abdominal pain is present in severe COVID-19 patients.

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Section: Discussionsupporting

confidence: 65%

A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

et al. 2022

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“…A total of 55 patients from the database research and 1 patient from our facility were included. 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Of the included studies, 12 were case series and 26 were case reports. Essential characteristics of the included patients are outlined in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

Aortic Thrombosis following COVID-19: A Systematic Review

Petrov¹,

Romera²,

Wilbring³

et al. 2022

Thorac Cardiovasc Surg

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Background Arterial and venous thromboses associated with the coronavirus disease 2019 (COVID-19) have been well described. These events are caused by a hypercoagulable state due to endotheliopathy and infection-driven coagulopathy. There has been an ever-increasing number of documented cases of aortic thrombosis (AoT) in COVID-19 patients. We conducted a systematic review of current scientific literature to identify and consolidate evidence of AoT in COVID-19 patients. Methods A systematic review of literature was conducted between March 15, 2020, and May 1, 2021, on PubMed and Cochrane databases. Additionally, a case from our facility was included. Results A total of 38 studies (12 case series and 26 case reports) and a case from our facility describing AoT in 56 COVID-19 patients were included. Patients were aged 64.8 ± 10.5 years, were predominantly male (75%), and had several comorbidities. AoT was symptomatic in 82,14% of patients; however, when D dimers were reported, they were significantly elevated even in otherwise asymptomatic patients. Most patients had no previous history of aortic disease. Thrombosis was described in all parts of the aorta, with several cases reporting multiple locations. The median reported time until development of AoT was 10 days. Peripheral thrombosis occurred in 73.21% of cases, most commonly causing lower limb ischemia. Mortality rate was 30.4%. Conclusions AoT can occur with no clinical symptoms or as a primary symptom in otherwise asymptomatic COVID-19 patients. D dimers are a highly sensitive diagnostic tool. Diagnosis of this condition prior to development of complications could be instrumental in saving many lives.

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“… 6 , 7 One of these cases regarded a 55-year-old male who presented with renal infarction and lower limb ischemia 6 and was managed with Fogarty embolectomy and anticoagulation. In the second case 7 a 74-year-old female presented with a dramatic clinical picture of aortic barrage but died before any treatment.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature a total of 6 cases of AFT involving the abdominal aorta have already been described, 4–9 2 of them in patients who had a concomitant COVID-19 infection. 6,7 One of these cases regarded a 55-year-old male who presented with renal infarction and lower limb ischemia 6 and was managed with Fogarty embolectomy and anticoagulation. In the second case 7 a 74-year-old female presented with a dramatic clinical picture of aortic barrage but died before any treatment.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Abdominal Aorta Floating Thrombus in a Patient with Recurrent Peripheral Embolization and COVID-19

Giannetta

Mazzaccaro

Righini

et al. 2022

Vasc Endovascular Surg

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Purpose To present stent-graft treatment of floating thrombus in the abdominal aorta. A review of the literature about aortic floating thrombus (AFT) was also performed. Case report A 56-year-old female with no risk factors for vascular disease but with history of a mild COVID-19 infection in the previous month, for which she had started anticoagulant therapy at a prophylactic dosage, developed an acute ischemia of the lower limbs and was diagnosed with floating thrombosis of the abdominal aorta. The thrombus was excluded from the aortic blood flow by deployment of a stent-graft in the abdominal aorta. At 12 months, the patient was well, and the thrombus in the abdominal aorta appears to be completely excluded by the stent-graft. A review of the available literature from 1980 to 2022 showed 74 cases of AFT located in the aortic arch, in the descending thoracic and in the abdominal aorta. In most cases the AFT involved the aortic arch (38/74, 51.3%) and/or the descending thoracic aorta (30/74, 40.5%), while the abdominal aorta was involved in 6 cases. In 2 of these 6 cases, the patients had a COVID-19 infection. The AFT was mostly approached either medically with anticoagulation/systemic thrombolysis (32/74, 43.2%) or with surgical removal (31/74, 41.9%), while endovascular coverage of the thrombus with an endograft was performed in 6 cases of AFT located in the aortic arch and in the descending thoracic aorta (3 cases each). Conclusion There is no consensus about the optimal treatment of AFT. In selected cases, abdominal stent-grafts may be used for stabilization and exclusion of symptomatic abdominal aorta floating thrombosis to prevent progression and recurrent embolization.

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Aortic Thrombosis in the Course of Covid-19 Disease; Two Rare Cases

Cited by 10 publications

References 11 publications

A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

Aortic Thrombosis following COVID-19: A Systematic Review

Endovascular Treatment of Abdominal Aorta Floating Thrombus in a Patient with Recurrent Peripheral Embolization and COVID-19

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