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Published on: December 19, 2020
Aortic floating thrombus in patients with COVID-19: a report of eight cases
K Soumer1, M Mallouki2, N Azabou2
1Department of Cardiovascular Surgery, Abderrahman Mami Hospital, Ariana, Tunisia. soumerkhedija@gmail.com.
Insights
COVID-19 can cause aortic thrombus, a rare but dangerous complication leading to limb ischemia. Early diagnosis and management are crucial to prevent severe outcomes like stroke and amputation.
Area of Science:
- Cardiology
- Infectious Diseases
- Vascular Surgery
Background:
- COVID-19 is linked to hyperinflammation and hypercoagulability, increasing thromboembolic event risk.
- Aortic thrombus is a rare but serious manifestation of SARS-CoV-2 infection.
Purpose of the Study:
- To characterize patients with COVID-19 presenting with aortic thrombus.
- To determine the clinical outcomes associated with aortic thrombosis in COVID-19 patients.
Main Methods:
- Retrospective, single-center descriptive study.
- Involved eight patients with confirmed SARS-CoV-2 infection and aortic thrombus.
- Data collected between June 2021 and December 2022.
Main Results:
- Aortic thrombus was diagnosed in all eight patients, with a mean age of 67.
- Six patients experienced acute limb ischemia; two had recurrent ischemia or distal embolization.
- Most patients required urgent revascularization, with outcomes including successful treatment, amputation, and death.
Conclusions:
- Aortic thrombosis is a rare, potentially fatal complication of COVID-19.
- High clinical suspicion is necessary for timely diagnosis and management of thromboembolic consequences.
- Prompt intervention can help avoid severe morbidities such as ischemic stroke and major amputations.
Background:
Thromboembolic events of COVID-19 are due to hyperinflammatory process associated with hypercoagulable state. The aim of the study was to determine characteristics and clinical outcomes of patients with COVID-19 who presented with aortic thrombus.
Methods:
We retrospectively conducted a single-center, descriptive study over a period of 1 year and 7 months, between June 2021 and December 2022, involving eight patients with documented SARS-CoV-2 infection associated with aortic thrombus revealed by acute limb ischemia.
Results:
The mean age of patients was 67 years with a median of 64, 5 ± 14. Of the eight included patients, six were men and two were women. Aortic thrombus was diagnosed in all cases. Six patients developed one episode of acute limb ischemia and one patient had recurrent upper and lower ischemia despite full anticoagulation whereas one patient had distal embolization with palpable pulses. In six patients, the thrombi were located in descending and abdominal aorta, while two patients presented with ascending aorta floating thrombus. Seven patients required urgent revascularization whereas medical treatment was recommended for one patient. The primary outcomes were successful in five cases, one patient had to be amputated above elbow, whereas two patients died due to a rapid deterioration of respiratory condition.
Conclusion:
Aortic thrombosis is a rare clinical presentation in SARS-CoV-2 infection but with potentially fatal embolic complication. Physicians should maintain a high degree of clinical suspicion to diagnose thromboembolic consequences of SARS-CoV-2 infection for timely management and avoiding morbidities like ischemic stroke and major amputations.
