Acute Aortic Thrombosis Research Articles

A Man with Sudden Onset Leg Pain and Weakness

Case Presentation: An 89-year-old male who had been holding dabigatran in the setting of transcarotid artery revascularization presented to the emergency department with sudden onset leg pain and weakness. Computed tomography angiography revealed acute aortic occlusion and thrombosis of the bilateral common iliac arteries. He underwent aortoiliac and femoral embolectomies and stenting of the bilateral common iliac arteries and returned to his baseline functional status. Discussion: Acute aortic occlusion is a rare but often devastating vascular emergency characterized by obstruction of the aorta by an embolus or thrombosis. Diagnosis can be challenging as it may be mistaken for spinal pathology, which can lead to delays in diagnosis. Despite advances in diagnostic modalities and interventions, acute aortic occlusion often results in high rates of major morbidity and mortality.

Acute Aortic Stent Graft Thrombosis in Patient with Recent COVID-19 Infection

Although COVID-19 primarily affects the respiratory system, it can have various effects on other organs, including the cardiovascular system. COVID-19 can lead to a prothrombotic status, promoting blood clotting, which can potentially affect native vessels and implanted devices. The exact mechanisms through which it leads to increased clotting are not yet fully understood but may involve inflammation, endothelial dysfunction, and a hyperactive immune response. In the present report, we describe a case of acute aortic stent graft thrombosis four days after the resolution of SARS-CoV-2 infection. The patient required emergent explantation of the stent graft after the failure of endovascular bailout procedures.

COVID-19-induced Neonatal Acute Aortic Thrombosis

Abstract Venous thromboembolism is a well-recognized, common complication of a severe COVID-19 disease. Arterial thrombosis is a less known complication, now being reported increasingly, mostly in the form of myocardial infarction and stroke, but acute aortic occlusion is infrequent. Neonatal acute aortic thrombosis as a sequelae of COVID-19 disease has far uncommon incidence with no literature-based evidence till date. A 10-day-old male child presented to the emergency department with informant being his mother with complaints of black discoloration of his right foot for 4 days noticed first on his toes. No history of trauma, no history of fever, and no history of umbilical artery catheterization at birth was noted. Birth history-full term normal vaginal delivery, small for gestational age baby, cried immediately after birth, birth weight – 2.45 kg with no additional birth events. No history of neonatal intensive care unit stay, immunized at birth. Baby was 3rd by order of birth with no congenital anomalies noted in previous siblings. On examination, the baby was alert, afebrile, heart rate – 138/min, blood pressure – 90/60 mmHg, and SpO2 98% on room air. Local examination of the right lower limb revealed black discoloration of the right lower limb from toes up to mid-calf, CRT-delayed in the right thigh (7 s), right femoral pulsations absent, left lower limb – pink, warm, CRT – 6 s, feeble pulsations of left femoral artery and popliteal artery, absent pulsations of left anterior tibial artery, and posterior tibial artery. A Doppler study revealed the presence of partial lumen occluding thrombus (hyperechoic) in abdominal aorta below the level of renal arteries, absent flow in right lower limb, and monophasic flow in left femoral artery. A prothtrombotic screen was performed and COVID-19 antibody test was found to be positive. A systemic thrombolysis with injection reteplase was performed which showed mild improvement in circulation with propagation of clot up to origin of superior mesentric artery on a Doppler scan. An abdominal aortic embolectomy was performed, with retrieval of a long segment thrombus from distal abdominal aorta and bilateral femoral arteries following good proximal inflow and good distal backflow. Bilateral limb perfusion improved postoperatively though the gangrenous right lower limb could not be saved and a right below knee amputation was performed for the same. This case adds to the growing list of potential sites and consequences of thrombosis in COVID-19 infection. We speculate that this case of aortic thrombosis was a result of direct COVID-19-induced vascular damage in the context of a hypercoagulable state with a possibility of vertical transmission of the disease.

Aortic thrombosis as a dramatic vascular complication in COVID-19 disease.

ObjectiveTo report clinical outcomes of COVID-19 related acute aortic thrombosis (AAT).MethodsConsecutive COVID-19 patients presenting with AAT between April 2020 and August 2021 were included retrospectively. Clinical and radiological data were prospectively collected.ResultsTen patients (men, 90%; mean age, 64 ± 2 years) were included. At the time of AAT diagnosis, four patients were in intensive care unit. Median time between diagnosis of COVID-19 and AAT was 5 days [IQR 0–8.5]. Clinical presentation was acute lower limb ischaemia (n = 9) and mesenteric ischaemia (n = 2). Thrombus localization was the abdominal aorta (n = 5), the thoracic aorta (n = 2) or both (n = 3), with the following embolic sites: lower limbs (n = 9), renal arteries (n = 3), superior mesenteric artery (n = 2), splenic artery (n = 1), cerebral arteries (n = 1). Revascularization was performed in 9 patients, using open (n = 6), endovascular (n = 2) or hybrid techniques (n = 1). Three patients required reinterventions. The 30-day mortality was 30%. Three major amputations were performed in two patients, resulting in a free-amputation survival rate of 50% after a median follow-up of 3,5 months [IQR 2–4.1].ConclusionAAT is a rare and devastating complication of COVID-19 disease, responsible for high mortality and amputation rates.

Acute aortic thrombosis in the ascending aorta after cisplatin-based chemotherapy for esophageal cancer: a case report

BackgroundThe risk of thrombus development is considered to be increased by malignant tumors and chemotherapy. In addition, thrombosis of the ascending aorta is rare. We report a case of ascending aortic thrombectomy in a patient with esophageal cancer who developed ascending aortic thrombus after starting neoadjuvant chemotherapy, including operative findings and surgical treatment.Case presentationA 63-year-old man with esophageal cancer was administered chemotherapy comprising cisplatin plus 5-fluorouracil. A week after completing 1 cycle of chemotherapy, computed tomography angiography showed acute aortic thrombosis at the ascending aorta. The risk of embolization appeared high because the thrombosis was floating, so we performed emergency ascending aortic thrombectomy. The postoperative course was good and uncomplicated. A month after this surgery, the patient underwent surgery for esophageal cancer. As of 1 year after the cancer surgery, neither cancer nor thrombosis has recurred.ConclusionWe describe a case of acute aortic thrombosis in the ascending aorta after cisplatin-based chemotherapy, that was treated by aortic thrombectomy. The treatment strategy should depend on thrombus location and the condition of the patient, but surgical treatment should be considered where possible to achieve better prognosis.

Acute aortic thrombosis in a patient with SARS-CoV-2 coronavirus disease (COVID-19)

One of the rare and life-threatening conditions is acute aortic thrombosis. We have described a case of thrombosis of the aorta and iliac arteries in a patient against the background of viral pneumonia COVID-19, with newly diagnosed diabetes mellitus and arterial hypertension.

Evolution and transformation of JVS-CIT

Evolution and transformation of JVS-CIT

Acute Aortic Thrombosis Complicated with Acute Abdomen in COVID-19 Patient

Acute Aortic Thrombosis Complicated with Acute Abdomen in COVID-19 Patient

Acute and Massive Aortic Thrombosis and Embolic Occlusion in a Patient with COVID-19: A Case Report

: A 73-year-old man with a history of COVID-19 infection from two weeks ago was referred to the Emergency Department with a complaint of colicky and generalized abdominal pain in addition to prior respiratory symptoms. High-resolution Computed Tomography (HRCT) displayed the typical signs of COVID-19 pneumonia. Initially, laboratory tests showed increased C-reactive protein and severe leukocytosis. Because of generalized abdominal pain, spiral abdominal and pelvic CT scans were done, which showed massive irregular and free-floating aortic thrombosis from the carina site to the Superior Mesenteric Artery (SMA) detachment, indicative of acute and life-threatening thrombosis. Filling defects were seen in the middle and distal part of the splenic artery, indicating the embolic occlusion of the splenic artery. The patient was admitted to the Intensive Care Unit (ICU), and he became a candidate for conservative treatment because of the wide extension of thrombosis. Therefore, we should pay more attention to the indirect signs of thrombosis in patients with COVID-19 infection with gastrointestinal symptoms and consider anticoagulant therapy for high-risk patients with COVID-19. The unique feature of our case was acute and extensive arterial thrombosis.

Acute aortic thrombosis as a presenting feature of COVID-19: case report and review of literature

Acute aortic thrombosis is an uncommon vascular emergency that can present with neurologic symptoms like acute paraplegia due to spinal cord ischemia. It frequently causes mortality unless appropriate diagnosis is followed immediately by proper management. Individuals with COVID-19 have coagulopathy with hyper inflammatory response which predisposes to both venous and arterial thrombotic events, especially in severe patients. We report a rare case of 63-year-old COVID-19 patient presenting as acute flaccid paraplegia with hematuria secondary to acute extensive aortic thrombus. CT scan showed bilateral COVID-19 pneumonia inspite of absence of respiratory symptoms. All patients with thrombotic events should be investigated for COVID-19 pneumonia as patients may not have typical respiratory symptoms.

Acute aortic thrombosis associated with COVID-19 infection

Angiología es una revista científica bimensual editada desde 1949. Está dedicada al estudio de las enfermedades vasculares, incluyendo todos los aspectos de la medicina vascular, el diagnóstico no invasivo, el tratamiento quirúrgico tradicional arterial y venoso, así como el mínimamente invasivo y/o endovascular.

Sudden Onset Lower Limb Pain and Paraesthesia: A Case Report

We describe the case of a woman with a metastatic pancreatic cancer and previous coronary artery disease who develops an acute Leriche syndrome. She arrived to emergency for onset orthopnea and dyspnoea on mild exertion. During the hospitalization is made a diagnosis of metastatic pancreatic adenocarcinoma. 10 days after admission suddenly the women reported severe pain in lower limbs and she was unable to maintain an upright position. Femoral, popliteal and posterior tibial pulses were not palpable bilaterally. At the Echo-doppler of the lower limbs limb pulses were barely appreciable with a tardus-parvus waveform. angiography showed critical thrombus formation in the sub-renal descending segment of the aorta and iliac arteries (which are CT commonly found in Leriche Syndrome); there was no perfusion of the inferior mesenteric artery; the internal and external iliac arteries as well as thigh and leg arteries showed slow and filiform flow with multiple sub-stenotic segments. Despite the immediate medical and surgical treatment woman died. Patients without known atherosclerosis risk factors should be investigated for hypercoagulable diseases or for co-morbidities which carry an increased risk of thrombo-embolism such as cancer. Considering that cancer and cardiovascular diseases are closely related, acute sub-renal aortic thrombosis should be considered when a patient presents with or develops unclear symptoms of sudden pain in the lower limbs with associated paralysis or paraesthesia and vascular investigations, such as ECHO-doppler and CT angiogram, must be performed.

Thrombotic complications of COVID-19.

IntroductionThe novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality. The impact of thrombotic complications has been increasingly recognized as an important component of this disease.ObjectiveThis narrative review summarizes the thrombotic complications associated with COVID-19 with an emphasis on information for Emergency Medicine clinicians.DiscussionThrombotic complications from COVID-19 are believed to be due to a hyperinflammatory response caused by the virus. Several complications have been described in the literature. These include acute limb ischemia, abdominal and thoracic aortic thrombosis, mesenteric ischemia, myocardial infarction, venous thromboembolism, acute cerebrovascular accident, and disseminated intravascular coagulation.ConclusionIt is important for Emergency Medicine clinicians to be aware of the thrombotic complications of COVID-19. Knowledge of these components are essential to rapidly recognize and treat to reduce morbidity and mortality in these patients.

Concomitant Acute Aortic Thrombosis and Pulmonary Embolism Complicating COVID-19 Pneumonia

There is rapidly accumulating literature regarding the hypercoagulable state associated with patients diagnosed with COVID-19 infection. Pulmonary, cardiac, and visceral involvement has been described. We describe a middle-aged male, with a background of diabetes and hypertension, diagnosed with severe COVID-19, who passed away despite maximum support. He had concomitant aortic and pulmonary thrombus. This is a devastating, poorly understood complication of severe COVID-19, adding to the body of medical literature related to severe COVID-19. COVID-19 is a hypercoagulable disease, and multi-organ involvement should be considered. Aortic imaging during a computed tomography pulmonary angiography can add additional information to the risk stratification and clinical implications in a patient diagnosed with COVID-19, with a suspected hypercoagulable state and possible multi-organ involvement.

Unusual arterial thrombotic events in Covid-19 patients

IntroductionCOVID-19 infection is commonly complicated with pro-thrombotic state and endothelial dysfunction. While several studies reported a high incidence of venous thromboembolic events. The occurrence of arterial thromboses are yet rarely described and could be underestimated. ObjectivesTo describe the clinical and biological characteristics of COVID-19 patients presenting with an associated arterial thromboembolic event. Material and methodsWe performed a retrospective multicentric study in 3 centers between France and Italy. All patients with a confirmed SARS-CoV-2 infection and arterial thromboembolic events were included in the analysis. ResultsFrom March 8th to April 25th 2020, we identified 20 patients (24 events) with arterial thromboembolic events over 209 admitted patients (9.6%) with severe COVID-19 infection. Arterial thrombotic events included acute coronary occlusions (n = 9), stroke (n = 6), limb ischemia (n = 3), splenic infarcts (n = 3), aortic thrombosis (n = 2) and occlusive mesenteric ischemia (n = 1). At the time of the event, 10/20 (50%) of patients received thromboprohylaxis, 2/20 (10%) were receiving treatment dose anticoagulation and 5/20 (25%) were receiving antiplatelet therapy. ConclusionOur observations suggest that serious arterial thrombotic events might occur in Covid-19 patients. However, the exact incidence of such events and the best way to prevent them yet remains to be investigated.

Acute aortic thrombosis presenting as acute limb ischemia in two young, non-atherosclerotic patients

Acute aortic thrombosis presenting as acute limb ischemia in two young, non-atherosclerotic patients

Acute aortic thrombosis in COVID-19

Acute aortic occlusion is an infrequent disease but with significant mortality. The new pandemic of the SARS-CoV-2 coronavirus disease (COVID-19) represents a great challenge for health systems. This contagious disease is generating high infection and mortality rates in several countries. It is speculated that the inflammatory process accompanying the infection is triggered by massive macrophage activation and is associated with the development of coagulopathy. We present three cases of COVID-19 patients, treated in our hospital during a period of 2 weeks, who presented with an acute thrombosis of the infrarenal abdominal aorta.

Acute Aortic Thrombosis Revealing a COVID-19 Infection

A 75 year old man was admitted with bilateral acute lower limb ischaemia. He had had a coronary artery bypass 15 years ago and remained on antiplatelet therapy. On physical examination, both limbs were ischaemic. Motor function was maintained. The electrocardiogram was normal. Computed tomography scan showed infrarenal aortic thrombosis (A, arrow) with pre-existing asymptomatic atherosclerosis. Systematic pulmonary examination revealed bilateral subpleural areas of ground glass opacification typical of COVID-19 pneumopathy (B, arrows). The polymerase chain reaction was positive. The limbs recovered with intravenous heparin. He was discharged on oral anticoagulants and was evaluated for revascularisation after the lockdown. COVID-19 may have contributed to the thrombosisImage 1

Acute Aortic Thrombosis Following Anterior Resection - A Rare Complication

INTRODUCTION : Anterior resection is a commonly performed surgery for rectal cancer worldwide. It is associated with a wide spectrum of complications which include haemorrhage, pelvic sepsis, wound infection, anastomotic breakdown, deep vein thrombosis, peripheral nerves injury, impotence and urological dysfunction. However acute aortic thrombosis post anterior resection is a very rare complication. CASE PRESENTATION : We report a rare case of aortic thrombosis in a 67 year old gentleman following anterior resection for rectal cancer. DISCUSSION : We also discuss its possible causes as there are many postulations to the cause of this devastating complication. Prolonged surgery, abnormal blood coagulation in cancer patient, lithotomy position and the presence of peripheral vascular disease are predisposing factors contributing to this rare acute aortic thrombosis in our patient. A standard routine neurovascular examination of the extremities should be done in the postoperative period to help detect early any neurovascular complication. The use of prophylactic anticoagulant such as fondaparinux, low molecular weight heparin or low dose unfractionated heparin are strongly recommended in high risk surgery patients undergoing a major surgery which helps prevent thromboembolic episode following surgery.

Acute Aortic Occlusion with Acute Onset of Paraplegia and Severe Hyposthenia

A 75-years-old man presented at our ED with acute onset of paraplegia and severe bilateral lower limb hyposthenia. The patient ‘s neurological assessment was negative except for lower limbs positive Mingazzini test. CT angiography detected a complete lack of opacification of the abdominal aorta immediately below the emergency of the inferior mesenteric artery, caused by a coarse thrombus in the left ventricle. We present a case of acute aortic and lumbar arteries thrombosis with paraplegia and no clear symptoms of acute limb ischemia, in which the motor deficit in the lower extremities was explained by anterior spinal cord syndrome secondary to acute occlusion of lumbar arteries.