P-036 - COVID-19 AND ENDOLEAK - A LETHAL COMBINATION

TOPIC:
Case Reports
AUTHORS:
Cohnert T. (Dept. of Vascular Surgery, Graz Medical University ~ Graz ~ Austria) , Siegl G. (Dept. of Vascular Surgery, Graz Medical University ~ Graz ~ Austria) , Stevanov M. (Dept. of Vascular Surgery, Graz Medical University ~ Graz ~ Austria) , Dudakovic E. (Dept. of Vascular Surgery, Graz Medical University ~ Graz ~ Austria)
Introduction:
The necessity for treatment of endoleaks after endovascular aortic aneurysm repair (EVAR), and the urgency of an additional procedure for endoleak treatment are still under discussion. The recommendations to aid thios decision currently include factors like type of endoleak, aneurysm diameter progression, and anticoagulation therapy. This case report adds the co-factor of an active COVID-19 infection to the discussion of what and when fo endoleaks after EVAR.
Methods:
A 72 year old man presented in the outpatient clinics because of new onset of intermittent claudication. His medical history included standard EVAR 3 years and 4 months prior for asymptomatic abdomainl aortic aneurysm. Magnetic resonance arteriography revealed an endoleak type III with major component dislocation and bilateral partial iliac artery obstruction.
Results:
Images were sent to the manufacturing company for analysis of the technical feasibility of endovascular re-repair. The patient was hospitalized and diagnosed with COVID-19 infection (PCR positive). Due to the symptomatic active COVID-19 infection, open conversion surgery was considered too risky for the patient. During the period until answer of redo EVAR feasibility, and with twice repeated positive PCR COVID-tests, the patient was found dead in the bathroom in the morning of day 8 of the hospitalization. Autopsy confirmed free aneurysm rupture as cause of death.
Conclusion:
In the recent literature, increeased rupture rates for AAA in patients with COVID-19 infections due to the inflammatory response (1, 2) are reported. This may also apply for patients post EVAR with evidence of endoleak, larger aneurysm diameter, and confirmed COVID_19 infection. A discussion of the necessity for intensified follow-up and additional imaging in endoleak patients post EVAR developing COVID-19 infection, and an adaptation of the treatment indication towards a more aggressive endoleak management is required.
References:
1. A. Bozzani, V. Arici, M. Franciscone, G. Ticozzelli, AV Sterpetti, F. Ragni. COVID-19 patients with abdominal aortic aneurysm may be at higher risk for sudden enlargement and rupture. J Vasc Surg. 2022;75:387-388. 2. B. Xu, G. Li, J. Guo, T. Ikezoe, K. Kasirajan, S. Zhao, et al. Angiotensin-converting enzyme 2, coronavirus disease 2019, and abdominal aortic aneurysms. J Vasc Surg, 2021; 74: 1740-1751.