Patients with AAAs who had COVID-19 may need ‘more frequent surveillance’ until better understanding of link emerges 

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Ronald L. Dalman

Patients who have known abdominal aortic aneurysms (AAAs), who may have had a COVID-19 infection, might need to have more frequent or a different surveillance regimen until a better understanding of the relationship between the virus and potential symptomatic progression or rapid enlargement of aneurysms is achieved.

Those were among the conclusions drawn by Ronald L. Dalman, MD, SVS president and chief of vascular surgery at Stanford University, California, during a discussion on the pandemic’s possible impact on the prevalence and progression of AAA worldwide at the Charing Cross (CX) 2021 Digital Edition (April 19–22).

Dalman had just presented details pointing to potential biologic links between the virus and AAA, describing “multiple lines of indirect evidence suggesting there may be some impact” across the globe. His talk was part of the Abdominal Aortic Controversies session.

“Clearly, in experimental modeling, in a number of experiments, we’ve shown that S1 protein promotes experimental aneurysm progression,” he told CX 2021. “There’s obviously questions regarding the potential impact of a few weeks of disease on a chronic condition such as aortic aneurysm disease that takes months or years to develop, but we also have this phenomenon of long-haul COVID.”

Dalman posed some of the resulting conundrums: Does the virus cause aneurysms versus just accelerate aneurysms? What are the implications for screening and surveillance? And what other COVID-19-related vascular conditions become apparent down the line?

Session moderator Gustavo Oderich, MD, professor and chief of vascular and endovascular surgery at the University of Texas’ McGovern Medical School in Houston, raised the point of reduced numbers of patients reporting for AAA screening studies as well as an increase in those presenting with ruptures. Oderich asked whether any changes had been made at Stanford aimed at reversing this trend.

Dalman reported seeing somewhere in the order of a 20% reduction in new patient visits to clinic. In terms of Vascular Quality Initiative (VQI) requirements, he said they had struggled to meet 80% one-year follow-up. “We are doing our best to try to reach out to patients, assure them it is safe to visit the hospital, to remind them their vascular health components remain important, but there is only so much you can do. Until a majority of the population is vaccinated, I think that’s going to continue to be a barrier to care.”

Stéphan Haulon, MD, a vascular surgeon at Hôpital Marie Lannelongue in Paris, France, pondered the implications of the unusual complications he witnessed following aortic surgery at the end of the first wave of the pandemic. “When we look back, most of these had a COVID infection a couple of weeks before, even if it was asymptomatic,” said Haulon. “What should be the delay between COVID infection and aortic surgery?” he asked.

Dalman reported experiencing similar incidences—”spontaneous arterial thromboses and strokes in young patients, and lower-extremity arterial occlusions in young people with no other risk factors.” He encouraged audience members to adhere to the emerging guidelines applicable to their particular cases.

In particular reference to what might be the true impact of long-haul COVID-19, Dalman referenced a National Institutes of Health (NIH) initiative looking into the consequences in all disease manifestations of the phenomenon.

“The important thing to keep in mind here is that patients who have known aneurysms, who may have had a COVID infection, may need to have more frequent or a different surveillance regimen until we have a better understanding of what the relationship is,” he said. “But no, at the current time, we have not recognized a relationship between the symptomatic progression or rapid enlargement of aneurysm in COVID-19 infection.”

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