Endovascular Treatment of a Ruptured Pararenal Abdominal Aortic Aneurysm in a Patient With Coronavirus Disease-2019: Suggestions and Case Report

Rinaldi, Luigi Federico; Marazzi, Giulia; Marone, Enrico Maria

doi:10.1016/j.avsg.2020.05.011

Cited by 17 publications

(17 citation statements)

References 7 publications

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“…Though there is no known association between COVID-19 and aneurysm formation, there may be accelerated thrombus formation in preexisting aneurysms. At least two cases of aortic aneurysm rupture during active COVID-19 infections have been reported [89,90]. A similar report exists for thrombosis in a popliteal aneurysm [91].…”

Section: Abnormal Blood Flowmentioning

confidence: 58%

Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad

2020

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The pathogenesis of Coronavirus disease 2019 (COVID-19) is gradually being comprehended. A high number of thrombotic episodes are reported, along with the mortality benefits of heparin. COVID-19 can be viewed as a prothrombotic disease. We overviewed the available evidence to explore this possibility. We identified various histopathology reports and clinical case series reporting thromboses in COVID-19. Also, multiple coagulation markers support this. COVID-19 can be regarded as a risk factor for thrombosis. Applying the principles of Virchow's triad, we described abnormalities in the vascular endothelium, altered blood flow, and platelet function abnormalities that lead to venous and arterial thromboses in COVID-19. Endothelial dysfunction, activation of the renin-angiotensin-aldosterone system (RAAS) with the release of procoagulant plasminogen activator inhibitor (PAI-1), and hyperimmune response with activated platelets seem to be significant contributors to thrombogenesis in COVID-19. Stratifying risk of COVID-19 thromboses should be based on age, presence of comorbidities, D-dimer, CT scoring, and various blood cell ratios. Isolated heparin therapy may not be sufficient to combat thrombosis in this disease. There is an urgent need to explore newer avenues like activated protein C, PAI-1 antagonists, and tissue plasminogen activators (tPA). These should be augmented with therapies targeting RAAS, antiplatelet drugs, repurposed antiinflammatory, and antirheumatic drugs.

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Section: Abnormal Blood Flowmentioning

confidence: 58%

Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad

2020

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“…The benefits of EVAR/TEVAR during the COVID-19 outbreak have been described. 9,10 Two patients were treated for carotid disease, with conventional patch endarterectomy, and 7 patients for hemodialysis access (fistula creation) by open means as well.…”

Section: Discussionmentioning

confidence: 99%

Adapting Vascular Surgery Practice to the Current COVID-19 Era at a Tertiary Academic Center in Madrid

Valdivia

Sanus

Santos

et al. 2020

Annals of Vascular Surgery

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Background: The epidemic potential of coronavirus infection is now a reality. Since the first case detected in late 2019 in China, a fast worldwide expansion confirms it. The vascular patient is at a higher risk of developing a severe form of the disease because of its nature associating several comorbid states, and thus, some vascular surgery communities from many countries have tried to stratify patients into those requiring care during these uncertain times. Methods: This is an observational study describing the current daily vascular surgery practice at one tertiary academic hospital in Madrid region, Spaindone of the most affected regions worldwide due to the COVID-19 outbreak. We analyzed our surgical practice since March 14th when the lockdown was declared up to date, May 14th (2 months). Procedural surgical practice, organizational issues, early outcomes, and all the troubles encountered during this new situation are described. Results: Our department is composed of 10 vascular surgeons and 4 trainees. Surgical practice has been reduced to only urgent care, totaling 50 repairs on 45 patients during the period. Five surgeries were performed on 3 COVID-19-positive patients. Sixty percent were due to critical limb ischemia, 45% of them performed by complete endovascular approach, whereas less than 10% of repairs were aorta related. We were allocated to use a total of 5 surgical rooms in different locations, none our usual, as it was converted into an ICU room while performing 50% of those repairs with unusual nursery staff. Conclusions: The COVID-19 outbreak has dramatically changed our organization and practice in favor of urgent or semiurgent surgical care alone. The lack of in-hospital/ICU beds and changing nursery staff changed the whole availability organization at our hospital and was a key factor in surgical decision-making in some cases.

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“…Studies were excluded if they reported tracheostomy outcomes only; did not involve a surgical intervention; the diagnosis of COVID-19 was based on symptoms or X-ray findings only; did not 16 Paris Urology All Yes Di Martino 17 Spain Gen Surg All Yes Alvarez Gallego 18 Spain Gen Surg All Yes Kayani 19 UK Ortho Emergency Yes Egol 20 USA Ortho Emergency Yes Cai 21 China Gen Surg Emergency Yes Javanmard-Emamghissi 22 UK Gen Surg Emergency Yes Barkhordari 23 Iran Cardiac Emergency Yes Sobti 24 UK Trauma/Orthopaedics Emergency Yes COVIDSurg Collaborative 8 Global All All No Dai 25 China Cancer Elective No Lei 26 China All Elective No Shrikhande 27 India Cancers Elective No Aminian 28 Iran Gen Surg Elective No Zhong 29 China Ortho/Gynae Emergency No Munoz Vives 30 Spain Ortho Emergency No Bellosta 31 Italy Vascular Emergency No Chen 32 China Caesarean Section Emergency No Senent-Boza 33 Spain All Emergency No Barret 34 Spain Burns Emergency No Hussain 35 London Cardiac Emergency No Li 36 China Thoracic Not stated No Case reports Gou, SM 37 China Pancreas Emergency Garcia-Portabella 38 Spain Ortho Emergency Davis-Sandfoss 39 USA Breast Cancer Elective Han 40 China Thoracic Emergency Lepre 41 Italy General Surgery Emergency Lyra 42 Portugal Obstetrics Elective Powezka 43 UK Vascular Emergency Qin 44 China Liver Transplant Emergency Rinaldi 45 Italy Vascular Emergency Stevenson 46 UK Ortho cancers Elective Sunkin 47 USA Orthopaedics Emergency Wen 48 China Neurosurgery Emergency Xuan 49 China Lung Transplant Emergency report on surgical outcomes; were incidence only studies, practice guidelines, consensus stateme...…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Mortality of patients with COVID‐19 who undergo an elective or emergency surgical procedure: a systematic review and meta‐analysis

Brown

Moore

Watters

2020

ANZ Journal of Surgery

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This meta‐analysis demonstrated that the odds ratio for mortality in patients who underwent a surgical procedure while coronavirus disease 2019 (COVID‐19) positive was 7.9 (95% confidence interval: 3.2–19.4) when compared with patients who were not COVID positive. This confirms findings from uncontrolled cohort studies and mandates health systems to seek ways to reduce the risk of operating on patients with COVID‐19, and when surgery is necessary, provide an environment where close monitoring for complications will enable early intervention.

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Endovascular Treatment of a Ruptured Pararenal Abdominal Aortic Aneurysm in a Patient With Coronavirus Disease-2019: Suggestions and Case Report

Cited by 17 publications

References 7 publications

Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad

Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad

Adapting Vascular Surgery Practice to the Current COVID-19 Era at a Tertiary Academic Center in Madrid

Mortality of patients with COVID‐19 who undergo an elective or emergency surgical procedure: a systematic review and meta‐analysis

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