Acute Thrombosis of an Aortic Prosthetic Graft in a Patient with Severe COVID-19–Related Pneumonia

Abstract

Background: COVID-19 infection has been reported to be related with an increased risk of thrombotic complications because of the hypercoagulability state and inflammation. At the moment, no reports are available regarding thrombosis of prosthetic vascular grafts. We present the case of a patient with COVID-19erelated pneumonia, who suffered from the acute thrombosis of a previously implanted aortic graft. Methods and results: A 67-year-old male patient, who had undergone open repair of an abdominal aortic aneurysm with a bifurcated graft 6 years before, was admitted to the emergency department with high fever for a week without cough or dyspnea. Thoracic ultrasound showed signs of bilateral interstitial pneumonia, and the Sars-Cov-2 swab was positive. Antiretroviral therapy and prophylactic low molecular weight heparin treatment were initiated. Owing to the progressive impairment of the respiratory function, the patient was intubated after eight days from the admission, the day after he showed signs of bilateral acute limb ischemia. A duplex ultrasound demonstrated the complete thrombosis of the aortic graft without flow at the femoral level. An urgent angio-computed tomography scan for revascularization purpose was requested, but the patient died on the arrival in the radiological suite. Conclusions: Acute thrombosis of vascular prosthetic grafts is a possible, catastrophic complication of COVID-19 infection. In COVID-19 patients with prosthetic graft, an aggressive antithrombotic treatment could be considered to prevent such an event.

Arterial thrombotic complications in COVID-19 patients

“…2,4,5 Furthermore, D-dimer levels were elevated in 15 of 17 patients tested in six identified case reports. [8][9][10][11][12][13] In our centers, D-dimer levels were determined in one patient and found to be significantly elevated. Although an apparent correlation is suggested, possible causality needs to be investigated.…”

“…The eight case reports describe the occurrence of acute arterial occlusions in the aorta and mesenteric and cerebral arteries. [6][7][8][9][10][11][12][13] Complications of COVID-19, including coagulopathy, 14,15 may contribute to the development of arterial ischemic events. Elevated D-dimer levels in the setting of COVID-19 have been described in three of the previously described cohort studies.…”

Coagulation disorders in SARS-CoV-2 infection

“…A complete thrombosis of the aortic graft in such a patient has recently been reported. A more aggressive prophylactic anticoagulant treatment is indicated in this category of patients 68 . But thrombosis can also occur in the coronary stents in these patients.…”

Acute Ischemic Stroke in COVID-19: A Case-Based Systematic Review

“…Interestingly Oxley et al noted an increased occurrence of younger SARS CoV2 virus-infected patients with no significant traditional risk factors for AIS, presenting with large vessel occlusion (6). Putative mechanisms suggested as inducing AIS in association with SARS CoV2 have included systemic inflammation, inflammatory cytokine storm, hyper-coagulability, and imbalances in the classical and alternative Renin Angiotensin System (RAS) in relation to SARS-CoV-2 spike glycoprotein-ACE2 binding related molecular mechanisms (3,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)). The RAS system comprises both a plasmabased RAS regulating cardiovascular system and tissue-based RAS regulating long term changes via a complex hormonal system, endocrine, paracrine, and autocrine in action.…”