key: cord-0733808-ii2yp4i7
authors: Giacomelli, Elena; Dorigo, Walter; Fargion, Aaron; Calugi, Gianmarco; Cianchi, Giovanni; Pratesi, Carlo
title: Acute thrombosis of an aortic prosthetic graft in a patient with severe COVID-19 related pneumonia
date: 2020-04-29
journal: Ann Vasc Surg
DOI: 10.1016/j.avsg.2020.04.040
sha: 5bed1063c2d6bafb37ecffd32859c064fe4e2798
doc_id: 733808
cord_uid: ii2yp4i7

Abstract Purpose COVID19 infection has been reported to be related with an increased risk of thrombotic complications due to hypercoagulability state and inflammation. At the moment no reports are available regarding thrombosis of prosthetic vascular grafts. We present the case of a patient with COVID19-related pneumonia, who suffered from the acute thrombosis of a previously implanted aortic graft. Case report A 67-year old male patient, undergone open repair of an abdominal aortic aneurysm with a bifurcated graft six years before, was admitted to the Emergency Department with high fever for a week without cough or dyspnea. Thoracic ultrasound showed signs of bilateral interstitial pneumonia and the Sars-Cov-2 swab was positive. Antiretroviral therapy and prophylactic low molecular weight heparin treatment were initiated. Due to the progressive impairment of respiratory function, the patient was intubated after eight days from the admission. The day after he showed signs of bilateral acute limb ischemia. A duplex ultrasound demonstrated the complete thrombosis of the aortic graft without flow at the femoral level. An urgent angio-computed tomography (CT) scan for revascularization purpose was requested, but the patient died upon the arrival in radiological suite. Conclusion Acute thrombosis of vascular prosthetic grafts is a possible, catastrophic complication of COVID19 infection. In COVID19 patients with prosthetic graft an aggressive antithrombotic treatment could be considered to prevent such an event.

This finding can explain why thrombosis did not occur immediately at hospitalization but after a 107 few days, in the moment when the inflammatory response in the patient was hyperactivated, as 108 reported in the late stages of the infection. 8 The patient was on heparin therapy at the prophylactic 109 dose of 50 IU/kg, which has not been enough to prevent the acute thrombotic event. 9 It is 110 reasonable to think that, if a patient with Sars-Cov-2 infection has a higher thrombotic risk, this will 111 be much higher in a patient with a vascular prosthesis. For this reason, it can be suggested that 112 patients with vascular prosthesis could be considered a selected subgroup, in which, in case of 113 COVID19, it is probably necessary to start an aggressive treatment with heparin at therapeutic 114 dosage. Acute aortic thrombosis is a condition associated with high mortality. Even in our case the 115 patient, who already showed very bad general condition due to the COVID19, died. If the general 

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