重症COVID-19関連肺炎患者における大動脈補綴グラフトの急性血栓症．

Acute Thrombosis of an Aortic Prosthetic Graft in a Patient with Severe COVID-19-Related Pneumonia.

• Elena Giacomelli
• Walter Dorigo
• Aaron Fargion
• Gianmarco Calugi
• Giovanni Cianchi
• Carlo Pratesi

抄録

背景:

COVID-19感染は、高凝固状態や炎症を起こすため、血栓性合併症のリスクの増加と関連していることが報告されています。現在のところ、補綴血管移植片の血栓症に関する報告はない。我々は，以前に移植した大動脈グラフトの急性血栓症を発症したCOVID-19関連肺炎患者の1例を紹介する．

BACKGROUND: COVID-19 infection has been reported to be related with an increased risk of thrombotic complications because of the 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 COVID-19-related pneumonia, who suffered from the acute thrombosis of a previously implanted aortic graft.

方法と結果:

6年前に腹部大動脈瘤を分岐グラフトで開放的に修復した67歳男性患者が，咳や呼吸困難を伴わず1週間高熱を呈して救急外来に入院した．胸部超音波検査で両側性間質性肺炎の徴候が認められ，Sars-Cov-2綿棒は陽性であった．抗レトロウイルス療法と低分子ヘパリンの予防的治療が開始された．呼吸機能の低下が進行していたため，入院から8日後に気管挿管したが，両側急性四肢虚血の兆候がみられた翌日に気管挿管した．二重超音波検査の結果，大腿レベルでの血流を伴わない大動脈グラフトの完全な血栓症が確認された．血行再建のために緊急に血管造影検査を依頼したが，放射線室に到着した時点で死亡していた．

METHODS AND RESULTS: A 67-year-old male patient, who had undergone open repair of an abdominal aortic aneurysm with a bifurcated graft 6 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. Owing to the progressive impairment of the 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 scan for revascularization purpose was requested, but the patient died on the arrival in the radiological suite.

結論:

血管補綴グラフトの急性血栓症は、COVID-19感染による壊滅的な合併症である可能性がある。COVID-19の補綴グラフト患者では、このようなイベントを予防するために積極的な抗血栓療法が考慮される可能性がある。

CONCLUSIONS: Acute thrombosis of vascular prosthetic grafts is a possible, catastrophic complication of COVID-19 infection. In COVID-19 patients with prosthetic graft, an aggressive antithrombotic treatment could be considered to prevent such an event.

Copyright © 2020 Elsevier Inc. All rights reserved.