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

OBJECTIVE: To report clinical outcomes of COVID-19 related acute aortic thrombosis (AAT). METHODS: Consecutive COVID-19 patients presenting with AAT between April 2020 and August 2021 were included retrospectively. Clinical and radiological data were prospectively collected. RESULTS: Ten 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]. CONCLUSION: AAT is a rare and devastating complication of COVID-19 disease, responsible for high mortality and amputation rates.