SARS-CoV-2-Induced Thrombosis of the Supra-Aortic Trunk in a Maintenance Hemodialysis Patient: A Case Report

Abstract

Introduction: The COVID-19 pandemic has been associated with an increased incidence of arterial and venous thromboses in patients undergoing maintenance hemodialysis, leading to more dialysis access thromboses. Observation: We report the case of an 84-year-old patient undergoing hemodialysis through an arteriovenous fistula (AVF). The patient presented with clinical symptoms related to SARS-CoV-2 infection along with biological markers indicative of an infectious syndrome. A chest CT angiography revealed severe viral pneumonia consistent with COVID-19 (CO-RADS 5). The patient was hospitalized due to respiratory instability and received oxygen therapy, antibiotic treatment, corticosteroids, vitamin supplementation, and preventive anticoagulation with enoxaparin. The patient’s condition was complicated by AVF thrombosis and required admission to the intensive care unit due to worsening respiratory distress. Another chest-abdomen-pelvic CT angiography conducted one month later revealed thrombosis of the supra-aortic trunk. This rare complication made any new vascular access for dialysis impossible due to the patient’s non-operability for the creation of a complex access site. One month later, the patient died of a pulmonary embolism. Conclusion: Given the severity of post-COVID-19 thromboembolic events in hemodialysis patients, particularly those hospitalized in intensive care, a low threshold of suspicion should be maintained for early screening. Treatment is urgent due to the functional and vital risks. An adaptation of anticoagulation protocols for this population could be considered to avoid such severe complications.