Abstract
Aim: As the novel coronavirus disease 2019 (COVID-19) pandemic impacts the global healthcare system, evolving data show increased frequency of arterial and venous thromboembolism among patients with COVID-19 infection. Aortic thrombus is a rare thrombotic event with a wide spectrum of clinical manifestations and potential catastrophic complications. This study aimed to elucidate the clinical manifestations, diagnosis and treatment dilemmas of aortic thrombus with COVID-19 infection and raise awareness among frontline medical providers. Aortic thrombosis is rare, but if not considered early in the course of COVID-19 infection, the data suggest that the diagnosis will probably not be made until potentially serious complications arise. Methods: Literature review was conducted between November 1, 2019, and November 14, 2020, on PubMed and Embase to identify publications regarding aortic thrombosis among COVID-19 cases. Results: Most of the patients were male with a median age of 67 years, and had comorbidities (most commonly hypertension, dyslipidemia and diabetes mellitus). In our study, underlying atherosclerosis, a common risk factor for aortic thrombus, was identified among 56% of the patients. Aortic thrombus was symptomatic in 62% of these patients and most commonly manifested itself as acute limb ischemia (46%), whereas 30% of cases were found incidentally during the investigation of elevated inflammatory markers or increased oxygen requirement. Treatment was individualized given the lack of established guidelines for aortic thrombus, including anticoagulation, systemic and catheter directed thrombolysis, and surgical thrombectomy. Overall mortality was found to be 30% in our study. Conclusions: Although rare, aortic thrombus has high morbidity and mortality, and can present without any symptoms or underlying aortic disease. Aortic thrombosis is rare, but if not considered early in the course of COVID-19 infection, the data suggest that the diagnosis will probably not be made until potentially serious complications arise.
Highlights
Aortic thrombus is a rare finding as an isolated event
COVID-19 status was demonstrated with reverse transcriptase polymerase chain reaction and aortic thrombus was diagnosed with computed tomography (CT) angiogram in all cases
We focused aortic thrombosis in patients with COVID-19, aiming to raise suspicion for a very likely association
Summary
Aortic thrombus is a rare finding as an isolated event. Diagnosis of aortic thrombus is made most often as an incidental finding in the company of other distal thromboembolic sites. Aortic thrombus has been identified without any underlying risk factor to explain thrombus formation. Given the rarity of disease and absence of randomized controlled trials, there is no consensus on the treatment of aortic thrombi and the management is individualized. In the course of the current pandemic, it has become increasingly clear that coronavirus disease 2019 (COVID-19) increases risk for thrombosis since a marked proportion of patients with severe COVID-19 infection develop venous and arterial thromboembolic complications. Most of the studies report thrombotic complications that are related to deep vein thrombosis and pulmonary embolism; data on aortic thrombosis in COVID-19 patients are limited. We emphasize the importance of making the diagnosis of aortic thrombus, given that, like aortic dissection, if not considered, probably will not be diagnosed early before catastrophic complications arise
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