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1.
J Cardiothorac Surg ; 16(1): 200, 2021 Jul 23.
Article in English | MEDLINE | ID: covidwho-1455985

ABSTRACT

BACKGROUND: The mural thrombus in the ascending aorta is rare, most of which are associated with aneurysm or atherosclerotic lesions, with high risks of causing catastrophic thrombotic events. A mural thrombus in the non-aneurysmal and non-atherosclerotic ascending aorta is exceptionally uncommon. CASE PRESENTATION: We reported a large mural thrombus in normal ascending aorta of an asymptomatic patient. Preoperative imaging confirmed the presence of the sessile thrombus located at the left anterior wall of ascending aorta. Given that it had the potential to cause fatal thrombotic complications, surgical removal and segment of ascending aorta replacement were executed. The patient had an uneventful recovery and discharged 14 days after surgery. CONCLUSIONS: Anticoagulant is the therapeutic cornerstone of ascending aortic thrombus, but surgery should be performed aggressively when the thrombus is large or floating to avoid severe embolic complications or recurrence.


Subject(s)
Aortic Diseases , Atherosclerosis , COVID-19 , Thrombosis , Aorta/surgery , Aortic Diseases/diagnostic imaging , Aortic Diseases/surgery , Atherosclerosis/complications , Atherosclerosis/diagnostic imaging , Humans , Male , Middle Aged , SARS-CoV-2 , Thrombosis/diagnostic imaging , Thrombosis/surgery , Treatment Outcome
2.
J Cardiovasc Surg (Torino) ; 62(6): 527-534, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1441430

ABSTRACT

INTRODUCTION: Since the outbreak of the 2019 coronavirus (COVID-19), vascular specialists have faced dramatic changes in clinical and surgical practice. Although COVID-19 pulmonary signs and symptoms were the most pertinent problems initially, in the long term, cardiovascular complications became the most fearsome, with poor outcomes in terms of morbidity and mortality. Algorithms and decision-making procedures have been modified, not only to treat new clinical findings in COVID-19 positive patients, but also to avoid complications related to pulmonary and systemic infections. Additionally, COVID-19-negative patients experienced challenging management, due to hospital crowding, the risk of nosocomial COVID-19 transmission, and pandemic emergencies. In this context, aortic interventions were subject to several difficulties. First, in COVID-19-positive patients, there was the onset of new pathological scenarios including thrombotic manifestations and the subsequent complications. Second, in both COVID-19-negative and positive patients, there was a need to deliver optimal treatment with acceptable perioperative risks, forcing a rethinking of decision-making especially in terms of indications for treatments. The aim of this systematic review is to present evidence published on COVID-19 and aortic-related issues, highlighting some challenging aspects regarding management, treatment and outcomes. EVIDENCE ACQUISITION: Data search was performed on PubMed, Scopus and Web of Science, using as time range "January 1st, 2000 - May 1st, 2021." Only articles in English language were included. Key words used for the query were "Aorta" AND "COVID-19" OR "SARS-CoV-2." Furthermore, the NCBI database of "SARS-CoV-2 Resources" was interrogated to find further relevant studies. EVIDENCE SYNTHESIS: The search retrieved 416 papers; among these, 46 studies were eligible and reviewed in depth. The published literature suggests the existence of a hypercoagulable state in patients with COVID-19 disease occurring via direct and indirect mechanisms. COVID-19 infection seems to promote a prothrombotic status that aggravates vascular disease. Regardless of clinical laboratory or status, active COVID-19 infection is considered a risk factor for poor vascular surgery outcomes. Specifically, it is associated with a fourfold increased risk of death and a threefold increased risk of major adverse events. Prognosis of patients hospitalized with COVID-19 disease is often determined by the extent of pulmonary disease, although vascular complications also greatly affect outcomes. Nevertheless, although COVID­19 is highly morbid, in high­risk operations good outcomes can still be achieved even in elderly patients with COVID­19. CONCLUSIONS: In the case of aortic disease during active COVID-19 infection, poor outcomes are associated with COVID-19 vascular and non-vascular complications, while for COVID-19-negative patients not much changed in terms of outcomes, despite the difficulties in management. Endovascular repair, when possible, minimized the impact of treatment, reducing the risk of COVID-related postoperative complications or acquired infection in negative patients.


Subject(s)
Anticoagulants/therapeutic use , Aortic Diseases/surgery , Blood Coagulation/drug effects , COVID-19/therapy , Endovascular Procedures , Thrombophilia/drug therapy , Vascular Surgical Procedures , Anticoagulants/adverse effects , Aortic Diseases/blood , Aortic Diseases/mortality , COVID-19/blood , COVID-19/mortality , Endovascular Procedures/adverse effects , Endovascular Procedures/mortality , Humans , Postoperative Complications/etiology , Risk Assessment , Risk Factors , Thrombophilia/blood , Thrombophilia/mortality , Treatment Outcome , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/mortality
3.
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
4.
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
5.
Ann Vasc Surg ; 75: 136-139, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1210816

ABSTRACT

INTRODUCTION: The SARS-CoV-2 infection is associated with significant morbidity and mortality rates. The impact of thrombotic complications has been increasingly recognized as an important component of this disease. CASE REPORTS: We describe four cases of spontaneous acute aortic thrombosis in patients with SARS-CoV-2 infection observed from March to December 2020 at Fondazione Policlinico Universitario Gemelli IRCCS in Rome, Italy.


Subject(s)
Aortic Diseases/etiology , COVID-19/complications , Thrombosis/etiology , Acute Disease , Aged , Aortic Diseases/diagnostic imaging , Aortic Diseases/surgery , COVID-19/diagnosis , Embolectomy , Fatal Outcome , Female , Humans , Male , Thrombectomy , Thrombosis/diagnostic imaging , Thrombosis/surgery , Treatment Outcome
6.
Ann Vasc Surg ; 75: 120-127, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1201420

ABSTRACT

OBJECTIVE: The COVID-19 pandemic has forced the cancellation of planned surgery and led to significant surgical service reductions. Early intervention in aortovascular disease is often critical and cannot be deferred despite these reductions. There is urgent need to evaluate the provision and outcomes of thoracic aortovascular intervention during the peak of the pandemic. METHODS: Prospective data was collected for patients receiving open and endovascular thoracic aortovascular intervention over two-time points; January-May 2020 and January-May 2019 at three tertiary cardiovascular centres. Baseline demographics, cardiovascular risk and COVID-19 screening results were noted. Primary outcomes were median length of intensive care unit and hospital stay, intra-operative mortality, 30-day mortality, post-operative stroke, and spinal cord injury. RESULTS: Patients operated in 2020 (41) had significantly higher median EuroSCORE II than 2019 (53) (7.44 vs. 5.86, P = 0.032) and rates of previous cardiac (19.5% vs. 3.8%, P = 0.019), aortic (14.6% vs. 1.9%, P = 0.041), and endovascular (22.0% vs. 3.8%, P = 0.009) intervention. There was an increase in proportion of urgent cases in 2020 (31.7% vs. 18.9%). There were no intra-operative deaths in 2020 and 1 in 2019 (P = 1.00). There were no significant differences (P ≥ 0.05) in 30-day mortality (4.9% vs. 13.2%), median intensive care unit length of stay (72 vs. 70 hr), median hospital length of stay (8 vs. 9 days), post-operative stroke (3 vs. 6), or spinal cord injury (2 vs. 1) between 2020 and 2019 respectively. CONCLUSIONS: Despite the increased mortality risk of patients and urgency of cases during COVID-19, complicated by the introduction of cohorting and screening regimens, thoracic aortovascular intervention remained safe with comparable in outcomes to pre-COVID-19.


Subject(s)
Aorta, Thoracic/surgery , Aortic Diseases/surgery , COVID-19 , Vascular Surgical Procedures , Aged , Aged, 80 and over , Aorta, Thoracic/diagnostic imaging , Aortic Diseases/diagnostic imaging , Aortic Diseases/mortality , COVID-19/diagnosis , COVID-19/mortality , COVID-19/prevention & control , COVID-19/transmission , COVID-19 Testing , Databases, Factual , England , Female , Hospital Mortality , Humans , Length of Stay , Male , Middle Aged , Patient Safety , Postoperative Complications/etiology , Prospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/mortality
7.
Heart Surg Forum ; 24(2): E372-E374, 2021 04 23.
Article in English | MEDLINE | ID: covidwho-1199988

ABSTRACT

The world has suffered over the past year under COVID-19. Unfortunately, people still are getting sick from other, also severe, diseases. Although the COVID-19 infection is present, patients need treatment for other life-threatening conditions. We present the case of a 36-year-old patient with severe infective endocarditis with a large abscess of the aortic root, who also is COVID-19 positive. Definitive diagnostics and treatment were avoided due to COVID-19 infection. In the end, emergent surgery was indicated due to acute cardiac decompensation and the development of heart failure symptoms, and the patient recovered uneventfully after surgery.


Subject(s)
Abscess/microbiology , Abscess/surgery , Aortic Diseases/microbiology , Aortic Diseases/surgery , COVID-19/complications , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/surgery , Heart Failure/etiology , Heart Failure/therapy , Abscess/diagnostic imaging , Adult , Aortic Diseases/diagnostic imaging , Endocarditis, Bacterial/diagnostic imaging , Heart Failure/diagnostic imaging , Humans , Male , Pleural Effusion/diagnostic imaging , Pleural Effusion/microbiology , Pleural Effusion/surgery , Pneumonia, Viral/complications , Pneumonia, Viral/virology , Respiration, Artificial , SARS-CoV-2
8.
Ann Vasc Surg ; 73: 114-118, 2021 May.
Article in English | MEDLINE | ID: covidwho-1064854

ABSTRACT

A total occlusion of the aorta is a rare condition; however, while rare, it has a very high mortality rate. Coronavirus disease 2019 (COVID-19) poses serious health problems, including vascular problems. Inflammatory changes produced by viral infections can cause serious disturbances in the coagulation system. Although cases showing a marked increase in thrombotic activity in the venous system have been presented, thrombosis in the arterial system, especially in the aorta, has rarely been reported. Here, we present 2 patients admitted to our hospital with an acute aortic thrombosis.


Subject(s)
Aortic Diseases/etiology , COVID-19/complications , Thrombosis/etiology , Acute Disease , Aged , Aortic Diseases/diagnostic imaging , Aortic Diseases/surgery , Fatal Outcome , Femoral Artery/surgery , Humans , Male , Middle Aged , Thrombectomy , Thrombosis/diagnostic imaging , Thrombosis/surgery , Tomography, X-Ray Computed
9.
J Card Surg ; 36(3): 848-856, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1029257

ABSTRACT

BACKGROUND: A significant restructuring of the healthcare services has taken place since the declaration of the coronavirus disease 2019 (COVID-19) pandemic, with elective surgery put on hold to concentrate intensive care resources to treat COVID-19 as well as to protect patients who are waiting for relatively low risk surgery from exposure to potentially infected hospital environment. METHODS: Multicentre study, with 19 participating centers, to define the impact of the pandemic on the provision of aortovascular services and patients' outcomes after having adapted the thresholds for intervention to guarantee access to treatment for emergency and urgent conditions. Retrospective analysis of prospectively collected data, including all patients with aortovascular conditions admitted for surgical or conservative treatment from the 1st March to the 20th May 2020. RESULTS: A total of 189 patients were analyzed, and 182 underwent surgery. Diagnosis included: aneurysm (45%), acute aortic syndrome (44%), pseudoaneurysm (4%), aortic valve endocarditis (4%), and other (3%). Timing for surgery was: emergency (40%), urgent (34%), or elective (26%). In-hospital mortality was 12%. Thirteen patients were diagnosed with COVID-19 during the peri-operative period, and this subgroup was not associated with a higher mortality. CONCLUSIONS: There was a significant change in service provision for aortovascular patients in the UK. Although the emergency and urgent surgical activity were maintained, elective treatment was minimal during early months of the pandemic. The preoperative COVID-19 screening protocol, combined with self-isolation and shielding, contributed to the low incidence of COVID-19 in our series and a mortality similar to that of pre-pandemic outcomes.


Subject(s)
Aortic Diseases/surgery , COVID-19/epidemiology , Emergencies , Pandemics , SARS-CoV-2 , Vascular Surgical Procedures/methods , Adult , Aged , Aged, 80 and over , Aortic Diseases/epidemiology , Comorbidity , Emergency Service, Hospital , Female , Humans , Incidence , Male , Middle Aged , Retrospective Studies , United Kingdom/epidemiology
10.
J Vasc Surg ; 73(1): 18-21, 2021 01.
Article in English | MEDLINE | ID: covidwho-963557

ABSTRACT

The severe acute respiratory syndrome novel coronavirus-2 pandemic is affecting almost every country in the world. Even if the major symptoms of coronavirus disease-2019 are respiratory, different symptoms at presentation are now recognized. Venous thromboembolism has been reported in infected patients and few but increasing cases of arterial thrombosis have been described. We report a case of acute aortoiliac and lower limb artery occlusions in a patient presenting with severe coronavirus disease-2019 infection. The mechanism of the occlusion seemed to be distal embolization from a floating thrombus in the aortic arch caused by a major inflammatory state and virus infection. The patient underwent aortoiliac and lower limb artery mechanical thrombectomy, but required unilateral major amputation.


Subject(s)
Aortic Diseases/etiology , Arterial Occlusive Diseases/etiology , COVID-19/complications , Iliac Artery , Thrombosis/etiology , Acute Disease , Amputation , Aortic Diseases/diagnostic imaging , Aortic Diseases/surgery , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/surgery , COVID-19/diagnosis , COVID-19/therapy , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/surgery , Male , Middle Aged , Thrombectomy , Thrombosis/diagnostic imaging , Thrombosis/surgery , Treatment Outcome
12.
J Vasc Surg ; 72(2): 408-413, 2020 08.
Article in English | MEDLINE | ID: covidwho-154754
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