Purpose
Corona virus disease 2019 (COVID-19) has been reported to cause thromboembolism, which may be treated with anticoagulation in severe cases. Vascular sequelae of this disease and treatment are poorly understood at this early stage of the pandemic. We report the only case series to date of hemorrhagic complications of COVID-19 treated with angiography.
Materials and Methods
An IRB-approved single institution retrospective study was conducted in patients with coronavirus infection through July 30, 2020. Diagnosis of coronavirus was confirmed with RNA RT-PCR; diagnosis of hemorrhage was made on clinical exam, CTA, and/or angiography.
Results
10 patients (median age 61 years; 5/5 M/F ratio) with COVID-19 and unprovoked hemorrhage were identified. 9/10 patients were receiving therapeutic dose anticoagulation at the time of hemorrhage. Sites of bleeding included gastrointestinal tract (4), lung (2), thigh (2), and retroperitoneum (2). Only 5 of the 10 patients had findings of active hemorrhage at the time of angiography. 3/10 patients had multiple concurrent sites of hemorrhage (range: 2-5 sites). 2/10 patients had pseudoaneurysms, including one patient with pulmonary artery pseudoaneurysms associated with lung consolidation. Embolization was performed in 8/10 cases (empirically in 3 cases); IVC filter placement was performed in 1 patient. Technical success was achieved in all cases with no procedural complications. Number of patients with hypotension decreased 24 hours following the procedure (from 7/10 to 1/10). 2/10 patients died within 7 days of the procedure from COVID-19-related disease.
Conclusions
COVID-19 can lead to spontaneous hemorrhage, which may present with atypical angiographic findings such as multiple sites of hemorrhage or abnormal pseudoaneurysm location. Interventional radiologists have a vital role in the management of this condition as embolization is both safe and effective in these patients.