Systemic Thrombolysis as Initial Treatment of COVID-19 Associated Acute Aortoiliac and Lower Extremity Arterial Thrombosis

Patel, Priya; Yu, Yasong; Zia, Saqib; Padberg, Frank T.; Curi, Michael A.; Huang, Joe

doi:10.1016/j.avsg.2020.08.083

Cited by 18 publications

(12 citation statements)

References 11 publications

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“…We were able to find one case report of systemic tPA administration for a patient who presented with acute aortoiliac and lower extremity arterial thrombosis. 21 tPA was successful in restoring patency of the proximal aortoiliac occlusion, which was followed by open thrombectomies, however the patient died on hospital day 17. It was concluded systemic fibrinolysis may be an adjunct to surgical or endovascular revascularization in patients with extensive arterial thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Acute aortic occlusion associated with COVID‐19: A rare complication of a not so rare disease

Lee

Hsu

2022

JACEP Open

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Recent literature has reported a high prevalence of thrombotic events associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) responsible for causing coronavirus disease 2019 (COVID‐19) infection. Although venous thromboembolism complications have been well studied, arterial thrombosis is less well described. Our aim is to describe acute aortoiliac occlusion (AAO), itself a rare condition, as a complication of COVID‐19 infection and review existing literature regarding its presentation and available treatment modalities. Over a 2‐week span in late 2021, 2 patients with recent COVID‐19 infection presented to our tertiary care hospital with AAO. Each case was treated with a multimodal therapeutic approach, including vascular interventional radiology guided thrombolysis, vascular surgical approach, and systemic anticoagulation. Although two separate primary approaches were taken, each resulted in high morbidity and death in both cases. Acute aortic occlusion is a rare disease associated with high morbidity and mortality. COVID‐19 has further been associated with arterial thromboembolic complications, including AAO, as presented here. More research is needed to identify patients at highest risk of developing arterial thromboembolic disease after COVID‐19 infection as well as to determine ideal therapeutic options in order to improve the exceedingly high morbidity and mortality associated with this complication.

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Section: Discussionmentioning

confidence: 99%

Acute aortic occlusion associated with COVID‐19: A rare complication of a not so rare disease

Lee

Hsu

2022

JACEP Open

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“…Systemic tPA and catheter-directed thrombolysis have been suggested as rapid treatment options, but these methods are contraindicated in surgical patients. However, due to poor prognosis and lack of appropriate treatments, thrombolytic regimens have also been suggested as off-label use (15).…”

Section: Discussionmentioning

confidence: 99%

Acute progressive arterial thrombosis after coronary artery bypass graft in a COVID-19 patient

et al. 2021

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The longer the SARS-CoV-2 pandemic takes, the greater the prothrombotic effects of the disease, which varies from venous thromboembolic events to limb arterial thrombosis and stroke. How we deal with the effects of the COVID-19 disease, is still unclear. In this study, researchers will report the clinical presentation, outcome and management of the patient with COVID-19 after coronary artery bypass graft (CABG) surgery, which led to rapid progression of arterial thrombosis. The COVID-19 positive patient underwent emergency CABG, due to developed coronary artery disease. Despite receiving high-dose preoperative Plavix and heparin and also postoperative aspirin, the patient developed progressive thrombosis in both lower extremities 4 days after surgery. It then spread to bilateral iliac arteries, aorta, abdominal and renal artery. Femoral endarterectomy was performed two times for atheromatous plaque removal which was unsuccessful and the patient died few days later due to multi-organ failure. COVID-19 is a risk factor for arterial thrombosis with high mortality and morbidity rate. If thrombosis happens, the prognosis will be poor. Comprehensive treatments have to be started immediately after diagnosis. In patients undergoing surgery for extensive arterial thrombosis due to poor prognosis, not only surgical revascularization is needed but also thrombolysis treatments may be considered as off-label use. As the pandemic continues, new approaches and interventions may be applied.

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“…Option for vascular intervention and revascularization depends on the extension of lesion and general condition of patients. 23 …”

Section: Cutaneous Manifestationsmentioning

confidence: 99%

Top 10 acral skin manifestations associated with COVID‐19: A scoping review

Farajzadeh

Khalili

Dehghani

et al. 2021

Dermatologic Therapy

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COVID‐19‐associated cutaneous manifestations are one of the most important and relatively common extra‐respiratory presentations of SARS‐COV‐2 infection. The exact identification and classification of these lesions can facilitate the accurate diagnosis and treatment. There are several case reports and small case series which describe cutaneous lesions in hands and feet. Currently, there is no scoping review about acral skin manifestations associated with COVID‐19. This paper covers the COVID‐related acral skin manifestations in 10 entities including acral papulo‐vesicular eruption, acral urticarial lesion, acral non‐inflammatory purpura and necrosis, acro‐ischemia associated COVID‐19, acral vasculitis, chilblain‐like lesion (COVID Toe), acral erythema multiform (EM) like lesion, hand and foot skin lesions associated with multisystem inflammatory syndrome in children (MISC), acral peeling conditions and red half‐moon nail sign. Future studies should focus on exact investigation of etiologies of these lesions including role of immune senescence, environment, gender, immunogenetics and relation of these lesion with major organ involvements.

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Systemic Thrombolysis as Initial Treatment of COVID-19 Associated Acute Aortoiliac and Lower Extremity Arterial Thrombosis

Cited by 18 publications

References 11 publications

Acute aortic occlusion associated with COVID‐19: A rare complication of a not so rare disease

Acute aortic occlusion associated with COVID‐19: A rare complication of a not so rare disease

Acute progressive arterial thrombosis after coronary artery bypass graft in a COVID-19 patient

Top 10 acral skin manifestations associated with COVID‐19: A scoping review

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