EVAR Solution For Acutely Thrombosed Abdominal Aortic Aneurysm in a Patient with COVID-19

INTRODUCTION: Acute thrombosis of an infrarenal abdominal aortic aneurysm (ATAAA) represents an uncommon but catastrophic pathology, which can lead to life threatening complications. This is a report of the infrequent use of an endovascular solution to successfully treat ATAAA in a patient with COVID-19 viral pneumonia and ischaemia induced lower extremity neurological deficits. REPORT: An 89 year old white male, with a history of cardiovascular comorbidities was admitted to the emergency room with dyspnoea associated with the sudden onset of abdominal and back pain followed by partial motor and sensory deficits in both legs. The CT scan showed both an 8 cm infrarenal AAA with middle (inferior mesenteric artery patent) and distal thrombotic occlusion of the sac and non-aneurysmal but thrombosed common iliac arteries. An additional finding was imaging features typical of interstitial pneumonia. After the molecular test detected active COVID-19 infection, the patient was treated as an emergency with an aorto-uni-iliac stent graft and femorofemoral crossover graft. The post-operative course was uneventful with AAA exclusion and disappearance of ischaemic symptoms. There were no vascular complications. At three month follow up the patient remained asymptomatic and was looking after himself. DISCUSSION: This case supports the feasibility and safety of a minimally invasive endovascular procedure to treat ATAAA in selected patients with favourable anatomy and high risk of respiratory complications in the context of the COVID-19 pandemic.