Tohmasi Steven, Kabutey Nii-Kabu, Maithel Shelley, Chen Samuel L, Kuo Isabella J, Donayre Carlos E, Fujitani Roy M, Chau Anthony H
University of California, Irvine Medical Center, Division of Vascular and Endovascular Surgery, Department of Surgery, Orange, CA, United States.
Ann Vasc Surg Brief Rep Innov. 2022 Sep;2(3):100105. doi: 10.1016/j.avsurg.2022.100105. Epub 2022 Jul 6.
Venous thrombosis has been widely described in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection; however, arterial thrombosis has rarely been reported. This study aims to assess the incidence, risk factors, interventions, and outcomes of acute aortoiliac arterial thrombosis in patients with active SARS-CoV-2 infections.
We present seven SARS-CoV-2-positive patients from our institution who acutely developed thrombi in the aortoiliac arterial system (7/2020-1/2021). A systematic review of the literature on aortoiliac arterial thrombosis in patients with SARS-CoV-2 infections in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was also performed. The available data from all reported cases in the literature and at our institution were analyzed.
Thirty published articles and journal correspondences, including 52 patients, were reviewed and analyzed in addition to our institution's 7 cases. In total, 59 SARS-CoV-2-positive patients were found to have acute aortoiliac thrombosis. The abdominal aorta was the most frequent location for the development of a thrombus. Baseline demographics and medical comorbidities were not significantly different between the symptomatic and asymptomatic cohorts. Seventy-one percent of patients were symptomatic (lower limb ischemia: 75.0%, renal infarction: 20.0%, stroke: 12.5%, mesenteric ischemia: 10.0%). All patients with thrombus involving the ascending aorta, aortic bifurcation, or iliac artery developed thromboembolic or ischemic complications. All patients received systemic anticoagulation. Fifty-three percent of all patients were managed medically. Ninety-four percent of the asymptomatic patients were managed medically. One asymptomatic patient underwent endovascular aspiration of a mobile thrombus. Three (23.1%) deaths occurred in the asymptomatic cohort from hypoxic respiratory failure. Fourteen (36.8%) deaths occurred in the symptomatic cohort. The in-hospital mortality rate was 33.3% overall and 43.8% for patients with thrombi involving more than one aortoiliac segment.
The presence of thrombi in the aortoiliac arterial system appears to be a poor prognostic indicator for patients with active SARS-CoV-2 infections. Medical management of patients with asymptomatic aortoiliac thrombi may be considered. The presence of thrombi involving the ascending aorta, aortic bifurcation, or iliac artery may warrant consideration for operative intervention due to the risk for thromboembolic or ischemic complications. Further study is needed to fully delineate the risk factors, optimal treatment, and outcomes of arterial thrombosis in the setting of SARS-CoV-2 infection.
静脉血栓形成在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染患者中已有广泛报道；然而，动脉血栓形成鲜有报告。本研究旨在评估活动性SARS-CoV-2感染患者急性主髂动脉血栓形成的发生率、危险因素、干预措施及预后。
我们报告了本院7例SARS-CoV-2阳性患者（2020年7月至2021年1月），这些患者在主髂动脉系统急性形成血栓。我们还根据系统评价和Meta分析的首选报告项目指南，对SARS-CoV-2感染患者主髂动脉血栓形成的文献进行了系统评价。对文献和本院所有报告病例的可用数据进行了分析。
除本院的7例病例外，我们还对30篇已发表的文章和期刊通信进行了回顾和分析，其中包括52例患者。总共发现59例SARS-CoV-2阳性患者患有急性主髂动脉血栓形成。腹主动脉是血栓形成最常见的部位。有症状和无症状队列的基线人口统计学和合并症无显著差异。71%的患者有症状（下肢缺血：75.0%，肾梗死：20.0%，中风：12.5%，肠系膜缺血：10.0%）。所有血栓累及升主动脉、主动脉分叉或髂动脉的患者均发生了血栓栓塞或缺血性并发症。所有患者均接受了全身抗凝治疗。53%的患者接受了药物治疗。94%的无症状患者接受了药物治疗。1例无症状患者接受了可移动血栓的血管内抽吸治疗。无症状队列中有3例（23.1%）死于低氧性呼吸衰竭。有症状队列中有14例（36.8%）死亡。总体住院死亡率为33.3%，血栓累及一个以上主髂动脉节段的患者住院死亡率为43.8%。
主髂动脉系统中存在血栓似乎是活动性SARS-CoV-2感染患者预后不良的指标。对于无症状主髂动脉血栓形成的患者，可考虑进行药物治疗。由于存在血栓栓塞或缺血性并发症的风险，血栓累及升主动脉、主动脉分叉或髂动脉的患者可能需要考虑手术干预。需要进一步研究以全面阐明SARS-CoV-2感染背景下动脉血栓形成的危险因素、最佳治疗方法及预后。
