Abdominal Aortic Occlusion in Setting of Covid-19

Introduction: The incidence of arterial thrombosis among critically ill patients with COVID-19 is 4.4%, acute aortic obstruction alone having a mortality rate of 31%. We present a review of the literature regarding isolated abdominal aortic thrombosis (IAAT) in the setting of COVID-19 infection, as well as a case presentation. Method(s): A literature review was performed using Pubmed with the keywords, aorta, aortic, thrombus, and Covid-19. Within these articles, the scope was narrowed to articles that related to IAAT in the setting of Covid-19 infection. Result(s): Our literature review found 9 articles detailing a total of 11 cases of IAAT in the setting of COVID-19 infection. IAAT had a mortality 22% (2 out of 9 patients). Approximately, 55% (6 out of 11) of the patients were treated with surgery and 27% (3 out of 11) received anticoagulation. 73%, (8 out of 11) of the patients in our literature review presented with symptoms of acute limb ischemia. Ages ranged from neonate to 85 years old, though 82% (9 out of 11) were over the age of 50. Conclusion(s): Our literature review suggests that IAAT is a serious complication of COVID-19 infection. IAAT is more common in males and people over the age of 50, which aligns with the 52 year- old male patient who presented to our clinic with lower extremity claudication and bilateral 1st & 5th toe cyanosis after COVID-19 infection. To prevent devastating limb ischemia, we emphasize early evaluation of claudication symptoms in patients with COVID-19 or recent COVID-19 infection.

Outcomes of large arterial vessel thrombosis in the setting of COVID-19

Background: COVID-19 infection can cause an array of symptoms including arterial thrombosis with an incidence of 4.4% however isolated large vessel thrombosis is even rarer. We present a review of the literature regarding large vessel (Iliac and aortic) thrombosis associated with COVID-19 infection and discuss the outcomes. In addition, we present a case that was infected with COVID-19 with presentation of isolated aortic thrombosis. Method(s): We performed a literature review using Pubmed keywords, COVID-19, iliac, aortoiliac, aorta, thrombosis. The articles were then narrowed to the ones only pertaining to aortic (AT) or iliac thrombosis (IT) with COVID-19 infection. Result(s): Our literature review found 12 articles detailing a total of 14 cases of AT or IT in the setting of COVID-19 infection. Ages ranged from neonate to 85 years old. Incidence of smoking was 30% and diabetes was 25%. Mortality rate was noted to be 14% (2 out of 14 patients). Approximately, 50% (7 out of 14) of the patients were treated with surgery and 21% (3 out of 14) received anticoagulation. 64%, (9 out of 14) of the patients presented with symptoms of acute limb ischemia. Amputation rate was noted to be 7% (1 out of 14). Conclusion(s): Large vessel thrombosis caused by COVID- 19 infections seems to carry high mortality and amputation rates. To prevent devastating sequel of COVID infection with concurrent large arterial thrombosis we emphasize that physicians employ a high index of suspicion and urgent involvement of the vascular interventionists. The case that we presented emphasized the importance of understanding the effect of COVID-19.