key: cord-0746109-bwwx8zyy
authors: Shih, Michael; Swearingen, Bruce; Rhee, Robert
title: Ruptured abdominal aortic aneurysm treated with endovascular repair in a patient with active COVID-19 infection during the pandemic
date: 2020-05-11
journal: Ann Vasc Surg
DOI: 10.1016/j.avsg.2020.05.001
sha: 41da6f63125cb9d0bcd5259887ac1718221e359f
doc_id: 746109
cord_uid: bwwx8zyy

We report a patient that presented with acute abdominal pain during the COVID-19 pandemic. His workup revealed rupture of a 5.8 cm abdominal aortic aneurysm. He presented with fever, cough, and shortness of breath and radiologic evidence of COVID-19 infection. After careful consideration, he underwent successful endovascular repair under local anesthesia with good short-term results.

In early 2020, the United States health system was inundated with the COVID-19 pandemic. In 27 New York City, the epicenter of the US outbreak, almost all hospital resources were directed 28 towards supporting surge beds for COVID patients. However, vascular surgery emergencies still 29 needed to be addressed. We describe a case of a ruptured abdominal aortic aneurysm (AAA) 30

presenting to a Brooklyn, NY hospital in the middle of the pandemic. Fundamental vascular 31 surgery treatment principles were maintained, with a few special considerations. He was seen 2 weeks after surgery without complaints. His CT at that time showed the 62 endograft to be satisfactory position with stable sac size (5.8 cm) and a small Type II endoleak. 63

The limbs were widely patent limbs with no mural thrombus. The retroperitoneal hematoma was 64 resolving, as were the ground glass opacities in the lungs. (Figure 3 ) The patient was enrolled 65 into our standard surveillance protocol, with repeat imaging at 6 months, 12 months, and then 66 yearly after that. At the time of this patient's presentation, our hospital had already set up 3 dedicated ORs for 94 COVID-19 positive patients, one of which was a hybrid room. These rooms were set up with 95 high efficiency particulate air (HEPA) filtration units. COVID carts were also placed in front of 96 each OR with bundles of complete personal proactive equipment (PPE). These were given to 97 every staff member that was required to enter the OR. These bundles contained a bouffant cap, 98 an N95 mask, face shield, full body ("bunny") suit, knee-high shoe covers, and elbow-high latex 99 gloves. After PPE was donned, we "scrubbed" the gloves with Avagard (chlorhexidine 100 gluconate 1% / ethyl alcohol 61%), then put on sterile gown and gloves over everything. All 101 non-essential personnel were prohibited from entering the OR. We utilized two circulating 102 nurses, one inside the OR and one outside the OR to prevent repeated entering and exiting. Ruptured AAA in COVID-19 positive patients can be treated endovascularly with satisfactory 140 short-term results. This is important as it can often be performed without intubation, thereby 141 minimizing risk of exposure to the surgeon and OR staff. Hospital preparedness during a 142 pandemic is also vital to success in emergent operations. Long term effects of implanting an 143 endograft during an active COVID-19 infection is unknown and will need to be monitored. 

Incidence of thrombotic complications in critically ill ICU patients with COVID-19

COVID-19 pandemic from a Vascular Surgery Unit in a Singapore Tertiary Hospital

Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, 154 and Follow-up

Doing the right thing for the right reason when 156 treating ruptured abdominal aortic aneurysms in the COVID-19 era

The 159 Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic 160 aneurysm

Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan

Decreased 165 mortality with local versus general anesthesia in endovascular aneurysm repair for ruptured 166 abdominal aortic aneurysm in the Vascular Quality Initiative database

Aerosol generating procedures and 169 risk of transmission of acute respiratory infections to healthcare workers: a systematic review