Acute aortoiliac occlusion in a patient with novel coronavirus disease-2019

Abstract

Coronavirus (SARS-Coronavirus-2:SARS-CoV-2) pandemic is affecting almost every country in the world. Even if the major symptoms of coronavirus disease-2019 (COVID-19) are respiratory, different symptoms at presentation are now recognized. Venous thromboembolism has been reported in infected patients and few but increasing cases of arterial thrombosis have been described. We report a case of acute aorto-iliac and lower limb artery occlusions in a patient presenting with severe COVID-19 infection. The mechanism of the occlusion seemed to be distal embolization from a floating thrombus in the aortic arch caused by a major inflammatory state and virus infection. The patient underwent aorto-iliac and lower limb artery mechanical thrombectomy but required unilateral major amputation.

Acute limb ischemia and aortic mural thrombosis as primary manifestations of severe acute respiratory syndrome coronavirus 2

“…Notably, while he suffered severe morbidity secondary to limb ischemia, even minor respiratory complications of SARS-CoV-2 were conspicuously absent during his clinical course. This is in contrast with other case reports wherein patients had respiratory symptoms prior to presentation or imaging consistent with respiratory disease burden in conjunction with thromboembolic events (6)(7)(8)(9)(10)(11)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26).…”

“…Emerging case reports describe arterial thrombotic events among patients with SARS-CoV-2, including AT and/or ALI with variable treatment approaches and clinical consequences (6)(7)(8)(9)(10)(11).…”

“…Patient outcomes range from thrombus resolution to re-embolization, catastrophic reperfusion injury and multi-organ failure despite aggressive surgical and medical intervention. A recent case study of AT and rapidly evolving bilateral ALI resulted in transtibial amputation after multiple revascularization attempts (9). For ALI without associated AT, a single center study has reported successful revascularization in 12/17 patient (70.6%) with one patient requiring amputation (12).…”

Early initiation of prophylactic anticoagulation for prevention of coronavirus disease 2019 mortality in patients admitted to hospital in the United States: cohort study

“…We acknowledge that the initiation of therapeutic anticoagulation might occur as a result of many reported complications of covid-19, including venous thromboembolism, arterial thromboembolism, cardiac arrhythmia, and disseminated intravascular coagulation. 59 60 61 62 63 64 65 66 We surmised that an intensification of anticoagulation indicated an adverse change in clinical condition, including these events. Fourth, this study was conducted on veterans currently receiving care in the Veterans Affairs healthcare system, who are older and have a higher prevalence of chronic health conditions and risk behaviors than the general US population.…”

Early initiation of prophylactic anticoagulation for prevention of COVID-19 mortality: a nationwide cohort study of hospitalized patients in the United States

“…However, the use of therapeutic anticoagulation may occur as a result of many reported complications of COVID-19 including venous thromboembolism, arterial thromboembolism, cardiac arrhythmia, and disseminated intravascular coagulation. [51][52][53][54][55][56][57][58] We surmised that an intensification of anticoagulation indicated an adverse change in clinical condition. Third, this study was conducted on Veterans currently receiving care in the VA, who are older and have a higher prevalence of chronic health conditions and risk behaviors than the general US population.…”