Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022:54:41-43.
doi: 10.1016/j.ejvsvf.2022.01.006. Epub 2022 Jan 22.

EVAR Solution For Acutely Thrombosed Abdominal Aortic Aneurysm in a Patient with COVID-19

Alessandro Robaldo  1 , Dimitri Apostolou  1 , Federica Persi  1 , Enrico Peano  2 , Massimo Maione  1
Affiliations
Case Reports

EVAR Solution For Acutely Thrombosed Abdominal Aortic Aneurysm in a Patient with COVID-19

Alessandro Robaldo et al. EJVES Vasc Forum. 2022.

Abstract

Introduction: Acute thrombosis of an infrarenal abdominal aortic aneurysm (ATAAA) represents an uncommon but catastrophic pathology, which can lead to life threatening complications. This is a report of the infrequent use of an endovascular solution to successfully treat ATAAA in a patient with COVID-19 viral pneumonia and ischaemia induced lower extremity neurological deficits.

Report: An 89 year old white male, with a history of cardiovascular comorbidities was admitted to the emergency room with dyspnoea associated with the sudden onset of abdominal and back pain followed by partial motor and sensory deficits in both legs. The CT scan showed both an 8 cm infrarenal AAA with middle (inferior mesenteric artery patent) and distal thrombotic occlusion of the sac and non-aneurysmal but thrombosed common iliac arteries. An additional finding was imaging features typical of interstitial pneumonia. After the molecular test detected active COVID-19 infection, the patient was treated as an emergency with an aorto-uni-iliac stent graft and femorofemoral crossover graft. The post-operative course was uneventful with AAA exclusion and disappearance of ischaemic symptoms. There were no vascular complications. At three month follow up the patient remained asymptomatic and was looking after himself.

Discussion: This case supports the feasibility and safety of a minimally invasive endovascular procedure to treat ATAAA in selected patients with favourable anatomy and high risk of respiratory complications in the context of the COVID-19 pandemic.

Keywords: Aneurysm; Aorta; COVID-19; Coagulopathy; Ischaemia; Thrombosis.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Computed tomography (CT) scan revealed acute thrombosis of an 8 cm infrarenal abdominal aortic aneurysm (AAA) and bilateral common iliac arteries with retrograde propagation of the aortic thrombus up to the level of the inferior mesenteric artery. (A) Maximum intensity projection (MIP) reconstruction. (B) Sagittal view of the lesion with the origin of the inferior mesenteric artery in addition to severe aortic and iliac calcification.
Figure 2
Figure 2
Preliminary angiography after the common iliac artery and aneurysm recanalisation.
Figure 3
Figure 3
Three dimensional reconstruction (A) and maximum intensity projection (MIP) reconstruction (B) confirm patency of the stent graft without any signs of stenosis.
See this image and copyright information in PMC

References

    1. Wong S.S.N., Roche-Nagle G., Oreopoulos G. Acute thrombosis of an abdominal aortic aneurysm presenting as cauda equina syndrome. J Vasc Surg. 2013;57:218–220. - PubMed
    1. Suliman A.S., Raffetto J.D., Seidman C.S., Menzoian J.O. Acute thrombosis of abdominal aortic aneurysm: report of two cases and review of the literature. Vasc Endovasc Surg. 2003;37:71–75. - PubMed
    1. Giannis D., Ziogas I.A., Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol. 2020;127:104362. - PMC - PubMed
    1. Leather R.P., Shah D., Goldman M., Rosenberg M., Karmody A.M. Non-respective treatment of abdominal aortic aneurysm. Use of acute thrombosis and axillofemoral bypass. Arch Surg. 1979;114:1402–1408. - PubMed
    1. Anastasiadou C., Giannakakis S., Papapetrou A., Galyfos G., Papacharalampous G., Maltezos C. Late rupture of a totally thrombosed abdominal aortic aneurysm: a case report and literature review. Ann Vasc Surg. 2018;46:368.e5–368.e8. - PubMed

Publication types