A case of covid-19-associated free-floating aortic thrombus successfully treated with thrombectomy

Abstract

Objective: Background: Case Report: Conclusions: Unusual clinical course COVID-19 caused by SARS-CoV-2 infection has been associated with a hypercoagulable state in which patients can be at risk for developing venous and arterial thromboembolic events at a rate as high as 31%. A free-float-ing aortic thrombus (FFT) is a rare life-threatening complication of a hypercoagulable state. These thrombi re-quire medical, endovascular, or surgical treatment. The optimal treatment modality for FFT occurring in the set-ting of COVID-19 remains unknown. We present a patient with a COVID-19-associated free-floating descending aortic thrombus that was treated with percutaneous vacuum-assisted thrombectomy (angio-VAC). A 61-year-old man presented to the hospital with dyspnea and hypoxia and was diagnosed with severe COVID-19 pneumonia. Initial chest computed tomography angiography (CTA) did not show pulmonary emboli or throm-bi. Inflammatory markers (D-dimer, lactate dehydrogenase, ferritin, fibrinogen) were tracked every other day. After several measurements of decreasing D-dimer values, there was a noticeable increase in D-dimer level and continued dependence on high levels of supplemental oxygen. A repeat chest CTA showed an FFT, confirmed by transesophageal echocardiogram. Cardiothoracic surgery and interventional radiology teams per-formed successful angio-VAC percutaneous removal, confirmed with intravascular ultrasound. The patient was subsequently discharged with a 3-month supply of apixaban. Minimally invasive endovascular removal of an FFT is a therapeutic option, as anticoagulation alone carries the risk of partial lysis and repeat embolization. Clinicians can consider this endovascular treatment option paired with therapeutic anticoagulation. Further guidelines on monitoring and treatment of possible COVID-19-associated thrombosis are needed, particularly when the risk of embolization is high.