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1.
Cardiovasc Res ; 117(9): 2045-2053, 2021 07 27.
Article in English | MEDLINE | ID: covidwho-1526155

ABSTRACT

Although coronavirus disease 2019 seems to be the leading topic in research number of outstanding studies have been published in the field of aorta and peripheral vascular diseases likely affecting our clinical practice in the near future. This review article highlights key research on vascular diseases published in 2020. Some studies have shed light in the pathophysiology of aortic aneurysm and dissection suggesting a potential role for kinase inhibitors as new therapeutic options. A first proteogenomic study on fibromuscular dysplasia (FMD) revealed a promising novel disease gene and provided proof-of-concept for a protein/lipid-based FMD blood test. The role of NADPH oxidases in vascular physiology, and particularly endothelial cell differentiation, is highlighted with potential for cell therapy development. Imaging of vulnerable plaque has been an intense field of research. Features of plaque vulnerability on magnetic resonance imaging as an under-recognized cause of stroke are discussed. Major clinical trials on lower extremity peripheral artery disease have shown added benefit of dual antithrombotic (aspirin plus rivaroxaban) treatment.


Subject(s)
Aortic Diseases , Biomedical Research/trends , Peripheral Vascular Diseases , Animals , Aortic Diseases/diagnosis , Aortic Diseases/epidemiology , Aortic Diseases/genetics , Aortic Diseases/therapy , COVID-19 , Clinical Trials as Topic , Diffusion of Innovation , Humans , Peripheral Vascular Diseases/diagnosis , Peripheral Vascular Diseases/epidemiology , Peripheral Vascular Diseases/genetics , Peripheral Vascular Diseases/therapy , Prognosis
2.
Ann Vasc Surg ; 77: 79-82, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1356137

ABSTRACT

A rare case of aortic thrombosis in a young COVID-19 positive patient is presented in this case report. Arterial thrombosis developed despite the administration of anticoagulants for treating DVT and PE. The patient underwent axillobifemoral bypass surgery. Limited surgical surveillance, administered steroids and critical health status resulted in wound site infection and consequent graft removal. Aortic endarterectomy and autovenous-patch plasty were performed after the patient's condition improved. Etiopathogenesis of arterial events in the setting of COVID-19 is not entirely understood. It has been suggested that SARS-CoV-2 infection strongly affects vascular endothelial glycocalyx (VEGLX), causes systemic inflammation - reactive microvascular endotheliosis (SIRME), and consequently results in arterial thrombosis.


Subject(s)
Aorta, Thoracic , Aortic Diseases/etiology , COVID-19/complications , Pulmonary Embolism/complications , Rare Diseases , Thrombosis/etiology , Venous Thrombosis/complications , Aortic Diseases/diagnosis , Aortic Diseases/surgery , Computed Tomography Angiography , Endarterectomy/methods , Endovascular Procedures/methods , Humans , Male , Middle Aged , Pulmonary Embolism/diagnosis , Pulmonary Embolism/drug therapy , SARS-CoV-2 , Thrombosis/diagnosis , Venous Thrombosis/diagnosis , Venous Thrombosis/drug therapy
3.
Semin Vasc Surg ; 34(2): 37-42, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1240791

ABSTRACT

The coronavirus disease 2019 (COVID-19) outbreak has profoundly affected all aspects of medicine and surgery. Vascular surgery practice and interventions were also forced to change in order to deal with new COVID-19-related priorities and emergencies. In this setting, difficulties in aortic disease management were two-fold: new vascular complications related to COVID-19 infection and the need to guarantee prompt and correct treatment for the general "non-COVID-19" population. Furthermore, discomfort deriving from precautions to minimize the risk of virus transmission among patients and among health care professionals, the need to separate COVID-19-positive from COVID-19-negative patients, and the high incidence of postoperative complications in COVID-19 cases created a challenging scenario for cardiac operations. The aim of this review was to provide evidence derived from the published literature (case reports, case series, multicenter experience, and expert opinion) on the impact of the COVID-19 outbreak on aortic vascular surgery services and interventions, describing COVID-19-related findings, intraoperative and postoperative outcomes, as well as the impact of the COVID-19 outbreak on noninfectious aortic patients.


Subject(s)
Aortic Diseases/surgery , COVID-19/epidemiology , Vascular Surgical Procedures/statistics & numerical data , Aortic Diseases/diagnosis , COVID-19/prevention & control , COVID-19/transmission , Facilities and Services Utilization , Humans , Procedures and Techniques Utilization
4.
Turk Kardiyol Dern Ars ; 49(3): 233-236, 2021 04.
Article in English | MEDLINE | ID: covidwho-1181749

ABSTRACT

As the COVID-19 pandemic continues, its novel complications are being increasingly recognized, and new mechanisms of the disease are being unraveled. Aortic free-floating thrombus is exceptionally rare, and prompt diagnosis is vital to alleviate its detrimental end organ effects. We present a patient who was previously discharged owing to COVID-19 pneumonia, admitted with acute onset of lower limb pain, and was diagnosed with aortic free-floating thrombus ended up with embolic events. Clinicians should be aware of COVID-19-related thromboembolic complications, and close monitoring of patients with risk factors is vital for a timely and accurate diagnosis and management.


Subject(s)
COVID-19/complications , Infarction/etiology , Ischemia/etiology , Kidney/blood supply , Lower Extremity/blood supply , Thromboembolism/etiology , Aortic Diseases/diagnosis , Aortic Diseases/etiology , Humans , Infarction/diagnosis , Ischemia/diagnosis , Male , Middle Aged , SARS-CoV-2 , Thromboembolism/diagnosis , Thrombosis/diagnosis , Thrombosis/etiology
5.
J Med Case Rep ; 15(1): 112, 2021 Mar 02.
Article in English | MEDLINE | ID: covidwho-1115251

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 infection can lead to a constellation of viral and immune symptoms called coronavirus disease 2019. Emerging literature increasingly supports the premise that severe acute respiratory syndrome coronavirus 2 promotes a prothrombotic milieu. However, to date there have been no reports of acute aortic occlusion, itself a rare phenomenon. We report a case of fatal acute aortic occlusion in a patient with coronavirus disease 2019. CASE REPORT: A 59-year-old Caucasian male with past medical history of peripheral vascular disease presented to the emergency department for evaluation of shortness of breath, fevers, and dry cough. His symptoms started 5-7 days prior to the emergency department visit, and he received antibiotics in the outpatient setting without any effect. He was found to be febrile, tachypneic, and hypoxemic. He was placed on supplemental oxygen via a non-rebreather mask. Chest X-ray showed multifocal opacifications. Intravenous antibiotics for possible pneumonia were initiated. Hydroxychloroquine was initiated to cover possible coronavirus disease 2019 pneumonia. During the hospitalization, the patient became progressively hypoxemic, for which he was placed on bilevel positive airway pressure. D-dimer, ferritin, lactate dehydrogenase, and C-reactive protein were all elevated. Severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction was positive. On day 3, the patient was upgraded to the intensive care unit. Soon after he was intubated, he developed a mottled appearance of skin, which extended from his bilateral feet up to the level of the subumbilical plane. Bedside ultrasound revealed an absence of flow from the mid-aorta to both common iliac arteries. The patient was evaluated emergently by vascular surgery. After a discussion with the family, it was decided to proceed with comfort-directed care, and the patient died later that day. DISCUSSION: Viral infections have been identified as a source of prothrombotic states due to direct injury of vascular tissue and inflammatory cascades. Severe acute respiratory syndrome coronavirus 2 appears to follow a similar pattern, with numerous institutions identifying elevated levels of thrombotic complications. We believe that healthcare providers should be aware of both venous and arterial thrombotic complications associated with coronavirus disease 2019, including possible fatal outcome.


Subject(s)
Aortic Diseases , Arterial Occlusive Diseases , SARS-CoV-2 , Thrombosis , Ultrasonography/methods , Aorta, Abdominal/diagnostic imaging , Aortic Diseases/diagnosis , Aortic Diseases/etiology , Aortic Diseases/physiopathology , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/physiopathology , Blood Coagulation , COVID-19/blood , COVID-19/complications , COVID-19/physiopathology , COVID-19/therapy , COVID-19 Nucleic Acid Testing/methods , Clinical Deterioration , Fatal Outcome , Humans , Male , Middle Aged , Patient Comfort , Point-of-Care Testing , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/physiopathology
8.
J Thromb Thrombolysis ; 51(1): 237-242, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-636047

ABSTRACT

Coronavirus disease 2019 (COVID-19) could predispose to both venous and arterial thromboembolism, in an exaggerated immune response to the virus, especially in severe patients. Even though aortic clots are a rare entity, the pro-coagulant nature of COVID-19 is associated with thrombosis in atypical locations and should be considered in patients with severe abnormalities in coagulation parameters. We describe a series of three cases of aortic thrombi diagnosed by computerized tomography (CT) angiography in patients with confirmed SARS-CoV-2 infection.


Subject(s)
Anticoagulants/administration & dosage , Aorta/diagnostic imaging , Aortic Diseases , COVID-19 , Thrombosis , Aged , Anticoagulants/classification , Aortic Diseases/diagnosis , Aortic Diseases/etiology , Aortic Diseases/physiopathology , COVID-19/blood , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , Computed Tomography Angiography/methods , Diagnosis, Differential , Fibrin Fibrinogen Degradation Products/analysis , Humans , Ischemic Stroke/diagnosis , Ischemic Stroke/etiology , Ischemic Stroke/physiopathology , Male , Middle Aged , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Pulmonary Embolism/therapy , SARS-CoV-2/isolation & purification , Severity of Illness Index , Thrombosis/blood , Thrombosis/diagnosis , Thrombosis/drug therapy , Thrombosis/etiology , Tomography, X-Ray Computed/methods , Treatment Outcome
9.
Ann Vasc Surg ; 67: 10-13, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-437505

ABSTRACT

COVID-19 may predispose patients to an increased risk of thrombotic complications through various pathophysiological mechanisms. Most of the reports on a high incidence of thrombotic complications are in relation to deep vein thrombosis and pulmonary embolism, while the evidence about arterial thrombosis in patients with COVID-19 is limited. We describe 4 cases of aortic thrombosis and associated ischemic complications in patients with severe SARS-CoV-2 infection.


Subject(s)
Anticoagulants/therapeutic use , Aortic Diseases/etiology , Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Thrombolytic Therapy/methods , Thrombosis/etiology , Aged , Aortic Diseases/diagnosis , Aortic Diseases/drug therapy , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Thrombosis/diagnosis , Thrombosis/drug therapy , Tomography, X-Ray Computed
12.
J Vasc Surg ; 72(2): 408-413, 2020 08.
Article in English | MEDLINE | ID: covidwho-154754
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