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Management of Coronavirus Disease 2019–Associated Great Vessel Aneurysmal Degeneration Through a Hybrid Approach
Abstract   Open access   Peer reviewed

Management of Coronavirus Disease 2019–Associated Great Vessel Aneurysmal Degeneration Through a Hybrid Approach

Adeola Titilayo Odugbesi, Thuan Nguyen and Maen Aboul Hosn
Journal of vascular surgery, Vol.74(4), pp.e387-e388
10/2021
DOI: 10.1016/j.jvs.2021.07.167
PMCID: PMC8479305
url
https://doi.org/10.1016/j.jvs.2021.07.167View
Published (Version of record) Open Access

Abstract

Background Although small or medium vessel vasculitis after coronavirus disease 2019 (COVID-19) infection has been observed, large vessel vasculitis with aneurysmal degeneration is a rare occurrence that has only been reported in a few cases. We report the successful hybrid repair of COVID-19–associated vasculitis and rapid aneurysmal degeneration of the innominate artery and right subclavian artery. Case report A 64-year-old woman with COVID-19 had presented with a pulmonary embolism 2 months after the diagnosis of COVID-19. A previous computed tomography angiogram of the chest had shown aortitis and aneurysmal changes of the innominate artery, right subclavian artery, and bilateral common carotid arteries. Repeat imaging showed rapid enlargement of the aneurysms, with the innominate artery aneurysm measuring 5 cm (increased from 2.1 cm 3 weeks previously) and the right subclavian artery aneurysm measuring 3.1 cm (increased from 1.2 cm 3 weeks prior; Fig 1). Her workup was negative for an underlying mycotic etiology; thus, immunosuppressive therapy was continued. A multidisciplinary approach, involving rheumatology, immunology, vascular surgery, and cardiac surgery, was used to manage her care. Owing to the rapid enlargement of the aneurysms, repair was indicated. Open aortic arch repair was deemed too high risk; thus, we elected to proceed with a combined endovascular and open approach through a neck incision. The procedure was a right carotid-to-subclavian bypass using an 8-mm ringed polytetrafluoroethylene graft with transcarotid retrograde exclusion of the innominate artery aneurysm using a 16-mm × 10-cm Excluder limb and 10-mm × 5-cm Viabahn stent graft (W.L. Gore & Associates, Flagstaff, Ariz). The subclavian artery origin was embolized with an 18-mm Amplatzer plug (Abbott Laboratories, Chicago, Ill) after coil embolization of the vertebral artery and internal mammary artery. Completion angiogram showed no endoleak. Postoperatively, the patient was extubated and remained neurologically intact. Subsequent computed tomography angiography of the neck and chest showed no endoleak (Fig 2). Conclusions Large vessel vasculitis and rapid aneurysmal degeneration are rare, but potentially life-threatening, latent complications of COVID-19 infection. A less invasive hybrid approach can be safely used in the acute setting, depending on the patient's clinical status.

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