Acute infrarenal abdominal aortic occlusion in a patient with COVID-19

A high rate of thrombotic complications have been observed in patients infected with COVID-19. These complications are related to increased blood hypercoagulabity, which can cause both venous and arterial thrombosis. We report a case of a 60-year-old man with COVID-19 pneumonia and thrombotic occlusion of the infrarenal abdominal aorta at the time of admission to the hospital. A CT scan showed a crazy-paving pattern in the lungs, consistent with COVID-19. A clinical suspicion of aortic thrombosis was confirmed by CT angiography. Embolectomy was undertaken a few hours later. At the end of the procedure, the patient was taken to the intensive care unit while intubated. The patient then worsened, developing severe renal failure, and died on day 1 after admission to the hospital. A CT scan, which is necessary for diagnosis of COVID-19, and a CT angiography, can be used to diagnose thrombotic events. It should be kept in mind that arterial thrombosis can be present not only in hospitalized COVID-19 patients but also at the time of admission. SIMILAR CASES PUBLSHED: 1

Efficacy of Precesarean Infrarenal Abdominal Aorta Balloon Occlusion Among Women With Pernicious Placenta Previa and Placenta Accreta: A Retrospective Cohort Analysis

Purpose To evaluate the efficacy and safety of prophylactic balloon occlusion of the infrarenal abdominal aorta among women with pernicious placenta previa and placenta accreta.Methods This retrospective study included 110 patients with pernicious placenta previa and placenta accreta. The control group consisted of 55 patients who underwent cesarean section alone, and the study group included 55 patients who underwent precesarean prophylactic balloon occlusion of the infrarenal abdominal aorta. In addition, both of the groups were further divided according to FIGO clinical grading standards. Prevention of hysterectomy was the primary outcome evaluated. The secondary outcomes included operative duration, estimated blood loss, blood transfusion, intensive care unit admission, total hospital stay (days), and puerperal morbidity, and these data were compared between the two groups. Additionally, the neonatal outcomes were compared.Results There were no significant differences in maternal and neonatal outcomes in the PAS 2 and PAS 3 groups (P > 0.05). However, in the PAS 4 and PAS 5 groups, the amount of bleeding in the study group was significantly less than that in the control group (3533.3 ± 2391.4 vs 4293.6 ± 1235.4, P < 0.05), and the total hysterectomy rate was also lower (7.8% vs 13.2%, P < 0.05).Conclusion Precesarean infrarenal abdominal aortic balloon occlusion is an effective and safe option for treating pernicious placenta previa and placenta accreta and can effectively reduce the risk of hysterectomy and intraoperative blood loss in women with PAS grade 4-5.

Eosinophilic Granulomatosis Polyangiitis (EGPA) Masquerading as a Mycotic Aneurysm of the Abdominal Aorta: Case Report and Review of Literature

Introduction. Aortic involvement leading to aortitis in eosinophilic granulomatosis polyangiitis (EGPA) is infrequent, and only 2 cases have been reported so far in the literature. Even more so, aortic aneurysm, secondary to EGPA, has never been reported and remains a diagnostic and therapeutic challenge. Case Presentation. We present a 63-year-old Caucasian male patient with a prior diagnosis of EGPA presenting with abdominal pain, nausea, and loose stools to the emergency department. Physical examination showed periumbilical tenderness. He had no peripheral eosinophilia but had high C-reactive protein and procalcitonin levels. CT abdomen revealed a mycotic aneurysm involving the infrarenal abdominal aorta. The patient declined surgical repair initially and was treated with IV antibiotics only. Unfortunately, 24 hours later, the aneurysm ruptured, leading to emergent axillofemoral bypass surgery. Surgical biopsy showed aortitis, periaortitis, and active necrotizing vasculitis. Conclusion. Abdominal aneurysms should be considered a complication of EGPA, and earlier immunosuppressive therapy should be considered to prevent further complications.

Temporary Cross-Clamping of the Infrarenal Abdominal Aorta during Cesarean Hysterectomy to Control Operative Blood Loss

Temporary cross-clamping of the infrarenal abdominal aorta to reduce bleeding during hysterectomy following cesarean section in patients with placenta previa-accreta is a relatively simple procedure; therefore, it can be an option when intravascular balloon catheter placement is impossible or encountered massive bleeding of the unexpected placenta accreta.

A case of successful surgical treatment of patient with rare vascular anomaly – hypoplasia of infrarenal abdominal aorta

Aim. To demonstrate a case of treatment of a patient with a rare vascular anomaly hypoplasia of infrarenal abdominal aorta. On a clinical example of female patient U., 41 years of age, with critical ischemia of the lower limbs and diagnosis hypoplasia of the abdominal aorta made on the basis of the clinical and instrumental data, the manifestations, diagnostics and potentials of the successful surgical treatment of the given pathology were demonstrated. Conclusion. Clinical manifestations of hypoplasia of the aorta depend on localization of the lesion and involvement of renal arteries. The commonest clinical sign is arterial hypertension and symptoms associated with the elevated arterial pressure. Hypoplasia of the aorta may also be manifested by hypertrophy of the upper limbs in combination with poor development of muscles of the lower limbs. More aged individuals present with arterial insufficiency leading to clinically significant ischemia of the lower limbs. Thus, in the case described, the patient already had ischemic trophic ulcers of the lower limbs. Without treatment, secondary arterial hypertension and cardiac failure may lead a patient to early death. Today, irrespective of the etiology, the only effective method of treatment of this disease is surgery. In case of our patient, resection of the hypoplastic segment of the aorta and its prosthetics were performed. This permitted to restore circulation in the lower parts of the body and further led to complete healing of trophic ulcers of the shin and to normalization of the systemic arterial pressure.

Upside-down and kissing stent graft techniques for late extravasation of a prosthetic graft implanted in the abdominal aorta

Extravasation of prosthetic grafts is rare. Various anatomical problems after graft replacement might make standard endovascular treatment difficult. Use of a commercially available main body requires an adequate distance of the flow divider. An 86-year-old man developed extravasation of a graft that had been implanted in the infrarenal abdominal aorta 24 years previously. Endovascular repair with upside-down and kissing stent graft techniques using the contralateral leg was successfully performed.

Resection of retroperitoneal soft-tissue sarcoma involving the abdominal aorta

Complete surgical resection of soft-tissue sarcomas (STSs) frequently requires complex multivisceral resections, which is the most important factor related to overall survival and local recurrence. Major vascular involvement is not rare in patients with primary retroperitoneal STSs. We present a 54-year-old woman with a retroperitoneal STS encasing the infrarenal abdominal aorta. The patient underwent complete oncological resection with vascular reconstruction using a bi-iliac vascular graft. Major blood vessel involvement is not a contraindication for STS surgery with a curative intent.