Acute thrombosis of an aortic prosthetic graft in a patient with severe COVID-19 related pneumonia

Purpose COVID19 infection has been reported to be related with an increased risk of thrombotic complications due to hypercoagulability state and inflammation. At the moment no reports are available regarding thrombosis of prosthetic vascular grafts. We present the case of a patient with COVID19-related pneumonia, who suffered from the acute thrombosis of a previously implanted aortic graft. Case report A 67-year old male patient, undergone open repair of an abdominal aortic aneurysm with a bifurcated graft six years before, was admitted to the Emergency Department with high fever for a week without cough or dyspnea. Thoracic ultrasound showed signs of bilateral interstitial pneumonia and the Sars-Cov-2 swab was positive. Antiretroviral therapy and prophylactic low molecular weight heparin treatment were initiated. Due to the progressive impairment of respiratory function, the patient was intubated after eight days from the admission. The day after he showed signs of bilateral acute limb ischemia. A duplex ultrasound demonstrated the complete thrombosis of the aortic graft without flow at the femoral level. An urgent angio-computed tomography (CT) scan for revascularization purpose was requested, but the patient died upon the arrival in radiological suite. Conclusion Acute thrombosis of vascular prosthetic grafts is a possible, catastrophic complication of COVID19 infection. In COVID19 patients with prosthetic graft an aggressive antithrombotic treatment could be considered to prevent such an event.