Acute Abdominal Aortic Occlusion in a COVID-19 Patient Despite Early Anticoagulation: A Case Report

Thromboembolic events related to coagulopathy have been frequently reported in patients with coronavirus disease 2019 (COVID-19), with elevated D-dimer levels being a significant risk factor for these events. While arterial thrombosis is less common than venous thrombosis, there are reports of myocardial infarction, ischemic stroke, and acute limb ischemia. Complete abdominal aortic occlusion, however, is exceptionally rare. We present a rare case of a 94-year-old male who developed complete abdominal aortic occlusion on day four of COVID-19 illness, despite early initiation of prophylactic anticoagulation along with standard antiviral and steroid therapy. The patient presented with a markedly elevated D-dimer level. After the sudden onset of severe pain from the back to the lower limbs, paralysis, and coldness of both legs, contrast-enhanced CT revealed thrombotic occlusion extending from the abdominal aorta to both iliac arteries. This case suggests that COVID-19-associated coagulopathy may progress to a severe state unmanageable by anticoagulation alone and underscores the importance of rapid evaluation and intervention for arterial thrombosis, including abdominal aortic occlusion, when acute limb ischemia-like symptoms occur.