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1.
Ann Vasc Surg ; 79: 438.e1-438.e4, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1456980

ABSTRACT

BACKGROUND: Vaccine Induced Thrombotic Thrombocytopenia (VITT) is a rare complication following ChAdOx1 (AstraZeneca) vaccination. Venous thrombosis in unusual sites such as splachnic or intracranial thrombosis, is the commonest manifestation. CASE REPORT: We report a 35-year-old male patient who presented with acute left leg ischemia and thrombocytopenia 11-days after vaccination requiring emergent thrombectomy. During work-up, a localized thrombus was detected in the left carotid bifurcation mandating carotid thrombectomy. Localized right iliac thrombus causing a non-limiting flow stenosis was treated conservatively. The platelet aggregating capacity of patient's plasma was confirmed in a functional assay, thereby establishing VITT. CONCLUSION: To the best of our knowledge this is the first case presenting multiple arterial thromboses requiring surgical treatment after ChAdOx1 vaccination.


Subject(s)
Arterial Occlusive Diseases/surgery , Carotid Artery Thrombosis/surgery , Femoral Artery/surgery , Thrombectomy , Thrombosis/surgery , Vaccination/adverse effects , Adult , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , Carotid Artery Thrombosis/diagnostic imaging , Carotid Artery Thrombosis/etiology , Femoral Artery/diagnostic imaging , Humans , Iliac Artery/diagnostic imaging , Male , Thrombosis/diagnostic imaging , Thrombosis/etiology , Treatment Outcome
2.
Vascular ; 30(3): 500-508, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1247555

ABSTRACT

OBJECTIVE: To report the results of a single-centre in the treatment of extensive aorto-iliac occlusive disease (AIOD) by the covered endovascular reconstruction of aortic bifurcation (CERAB) technique. METHODS: A retrospective analysis was conducted on data obtained from the review of medical charts of all consecutive patients treated with CERAB technique for AIOD between January 2016 and December 2019 in San Giovanni-Addolorata Hospital (Rome, Italy). Clinical examination, duplex ultrasound with ankle-brachial index measurement and contrast-enhanced computed tomography angiography were performed preoperatively. A clinical and ultrasound follow-up was carried out at one month and then half yearly after the intervention to evaluate patients' clinical status, limb salvage, target lesion revascularization rate, primary and secondary patency rate. RESULTS: During the study period, 24 patients (14 men, 58.3%; 10 women, 41.7%; median age 59 years, range 37-79 years) underwent CERAB for AIOD (TASC II C 29.2%, TASC II D 70.8%). Indications for treatment were: intermittent claudication in 18 patients (75%) and critical limb ischemia in 6 (25%). Technical success was achieved in all cases. Perioperative minor complications occurred in three cases (12.5%). One patient reported an intraoperative iliac rupture requiring adjunctive covered stenting. Median hospital length of stay was two days (range 1-9). No patient died perioperatively nor at the last follow-up. At a median follow-up of 18 months (range 6-48 months), mean ankle-brachial index increased significantly (from 0.62 ± 0.15 before the procedure to 0.84 ± 0.18) (P < 0.001) and target lesion revascularization rate was 12.5%. At two years, the limb salvage rate was 100%, and primary and secondary patency rates were 87.5% and 100%, respectively. CONCLUSION: CERAB technique demonstrated to be effective at the mid-term follow-up with low rate of complications and short length of stay. Long-term results and more robust data are needed to affirm this technique as the first-line treatment for extensive AIOD. However, it could become the preferred option especially in fragile patients and during contemporary COVID-19 pandemic due to the current limitations in vascular and critical care bed capacity.


Subject(s)
Aortic Diseases , Arterial Occlusive Diseases , COVID-19 , Endovascular Procedures , Leriche Syndrome , Adult , Aged , Aortic Diseases/diagnostic imaging , Aortic Diseases/etiology , Aortic Diseases/surgery , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/surgery , Endovascular Procedures/adverse effects , Female , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/surgery , Male , Middle Aged , Pandemics , Retrospective Studies , Stents , Treatment Outcome , Vascular Patency
4.
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
5.
Ann Vasc Surg ; 70: 297-301, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-733967

ABSTRACT

SARS-CoV-2 (COVID-19) patients with associated thromboembolic events have demonstrated poor outcomes despite the use of anticoagulation therapy and surgical intervention. We present a COVID-19 patient with acute limb ischemia, secondary to extensive thrombosis of an aortic aneurysm, iliac arteries, and infrainguinal arteries. Initial treatment with systemic thrombolysis, which restored patency of the aortoiliac occlusion, was followed by open thrombectomies of the infrainguinal occlusions.


Subject(s)
Aortic Aneurysm, Abdominal/complications , Arterial Occlusive Diseases/drug therapy , COVID-19/complications , Fibrinolytic Agents/administration & dosage , Iliac Artery , Thrombolytic Therapy , Thrombosis/drug therapy , Tissue Plasminogen Activator/administration & dosage , Aged , Aortic Aneurysm, Abdominal/diagnostic imaging , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases/physiopathology , COVID-19/diagnosis , Humans , Iliac Artery/diagnostic imaging , Iliac Artery/physiopathology , Infusions, Intravenous , Male , Thrombectomy , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/physiopathology , Treatment Outcome , Vascular Patency
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