Outcomes of large arterial vessel thrombosis in the setting of COVID-19

ABSTRACT

Background: COVID-19 infection can cause an array of symptoms including arterial thrombosis with an incidence of 4.4% however isolated large vessel thrombosis is even rarer. We present a review of the literature regarding large vessel (Iliac and aortic) thrombosis associated with COVID-19 infection and discuss the outcomes. In addition, we present a case that was infected with COVID-19 with presentation of isolated aortic thrombosis. Method(s) We performed a literature review using Pubmed keywords, COVID-19, iliac, aortoiliac, aorta, thrombosis. The articles were then narrowed to the ones only pertaining to aortic (AT) or iliac thrombosis (IT) with COVID-19 infection. Result(s) Our literature review found 12 articles detailing a total of 14 cases of AT or IT in the setting of COVID-19 infection. Ages ranged from neonate to 85 years old. Incidence of smoking was 30% and diabetes was 25%. Mortality rate was noted to be 14% (2 out of 14 patients). Approximately, 50% (7 out of 14) of the patients were treated with surgery and 21% (3 out of 14) received anticoagulation. 64%, (9 out of 14) of the patients presented with symptoms of acute limb ischemia. Amputation rate was noted to be 7% (1 out of 14). Conclusion(s) Large vessel thrombosis caused by COVID- 19 infections seems to carry high mortality and amputation rates. To prevent devastating sequel of COVID infection with concurrent large arterial thrombosis we emphasize that physicians employ a high index of suspicion and urgent involvement of the vascular interventionists. The case that we presented emphasized the importance of understanding the effect of COVID-19.