Case Report of Thrombosis of the Distal Aorta with Occlusion of Iliac Arteries in COVID-19 Infection

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for the coronavirus disease of 2019 (COVID-19) pandemic, has been associated with a variety of prothrombotic sequelae. The pathogenesis of this hypercoagulability has not yet been fully elucidated, but it is thought to be multifactorial with overactivation of the complement pathways playing a central role. There is emerging evidence that the resulting complications are not confined to the venous circulation, and even in patients without typical respiratory symptoms or traditional risk factors, there is a significant rate of arterial thromboembolic disease in patients with SARS-CoV-2 infection. Case Report: We describe a patient presenting with bilateral leg pain without any respiratory symptoms or fever who ultimately was found to be COVID-19 positive and had thromboembolism of the aorta and bilateral iliac occlusion. This report reviews available evidence on the prevalence of arterial thromboembolism in COVID-19 patients and some proposed mechanisms of the pathophysiology of COVID-19-associated coagulopathy. Conclusion: It is important that the emergency physician maintain a high degree of suspicion for arterial thromboembolic disease in patients who are infected with COVID-19 even in the absence of typical respiratory symptoms. Additionally, COVID-19 should be considered in patients with unexplained thromboembolic disease, as this may increase the detection of COVID-19. [Clin Pract

Severe thrombosis of abdominal aorta with distal embolism as the only clinical manifestation of Covid-19 infection

“…Among the COVID-19 patients with acute leg ischemia, there were mostly thromboembolic events of the femoral or popliteal artery with frequent history of cardiovascular risk factors (3,4). Cases like ours, with large arterial thrombosis that nearly occluded aorta with massive peripheral embolic occlusion on both legs, were rare, especially in patients without previous cardiovascular disease or risk factors (10,11). Vulliamy and al reported two cases of major occlusive arterial events in patients with confirmed symptomatic COVID-19 who did not have previous peripheral artery disease, but they developed respiratory symptoms before the arterial thrombosis (6).…”

Aortic Thrombosis following COVID-19: A Systematic Review

“…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 .…”

A Novel Percutaneous Technique for Aorto-Iliac Thrombectomy without the Risk of Embolization

“…Since the start of the COVID-19 pandemic, COVID-19 infections have repeatedly been reported to be associated with thrombotic events [1]. These events include appositional thrombi localized in the thoraco-abdominal aorta and iliac arteries, at times even leading to complete occlusion of these vessels [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”