Surgical clinical characteristics of acute arterial thrombosis of the extremities in the context of SARS-CoV-2 infection

Objective: To determine the clinical-surgical features of critical limb ischaemia (CLI) within the context of infection by SARS-CoV-2. Method(s): Cross-sectional, retrospective, observational, descriptive study, with clinical data obtained from printed and electronic records of patients with CLI treated by the Angiology and Vascular Surgery Service of the General Hospital of Mexico in the period between January 2020 and July 2021. Result(s): We evaluated the data of 33 patients with critical limb ischaemia of which 15 were positive for SARS-CoV-2 in the period from January 2020 to July 2021, females were the most affected representing the 53.3% of the total, patients under 60 years old accounted for 26.67%. Twenty-six percent of the patients presented critical limb ischaemia without having previous comorbidities, 60% of these presented with an advanced state of the disease and a delay in specialised medical care of more than 6 hours after the onset of symptoms, which warranted a major amputation in 37% of cases, the lower extremities represented 90% of the affected anatomical regions. Conclusion(s): the outcomes in our study show that the incidence of critical limb ischaemia during the SARS-CoV2 pandemic period occurred in an atypical way in a segment of young patients and without known event-generating comorbidities. Thromboembolic events, probably associated with the hypercoagulable state generated by this infection, also evolved rapidly and aggressively from the onset of symptoms despite prompt treatment.Copyright © 2022 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.

Abdominal Aortic Occlusion in Setting of Covid-19

Introduction: The incidence of arterial thrombosis among critically ill patients with COVID-19 is 4.4%, acute aortic obstruction alone having a mortality rate of 31%. We present a review of the literature regarding isolated abdominal aortic thrombosis (IAAT) in the setting of COVID-19 infection, as well as a case presentation. Method(s): A literature review was performed using Pubmed with the keywords, aorta, aortic, thrombus, and Covid-19. Within these articles, the scope was narrowed to articles that related to IAAT in the setting of Covid-19 infection. Result(s): Our literature review found 9 articles detailing a total of 11 cases of IAAT in the setting of COVID-19 infection. IAAT had a mortality 22% (2 out of 9 patients). Approximately, 55% (6 out of 11) of the patients were treated with surgery and 27% (3 out of 11) received anticoagulation. 73%, (8 out of 11) of the patients in our literature review presented with symptoms of acute limb ischemia. Ages ranged from neonate to 85 years old, though 82% (9 out of 11) were over the age of 50. Conclusion(s): Our literature review suggests that IAAT is a serious complication of COVID-19 infection. IAAT is more common in males and people over the age of 50, which aligns with the 52 year- old male patient who presented to our clinic with lower extremity claudication and bilateral 1st & 5th toe cyanosis after COVID-19 infection. To prevent devastating limb ischemia, we emphasize early evaluation of claudication symptoms in patients with COVID-19 or recent COVID-19 infection.

Arterial Thrombosis and Acute Limb Ischemia as a Complication of COVID-19 Infection.

COVID-19 refers to viral respiratory infections and is the predisposing factor for the development of venous and arterial thrombotic events due to a pronounced inflammatory response, platelet activation, endothelial dysfunction, and stasis. Recent studies have confirmed a high incidence of thromboembolic events, especially in the group of patients with severe coronavirus pneumonia. There have been an increasing number of reports of peripheral arterial thrombosis as well. Most cases of arterial thrombosis are noted in critical ill patients in intensive care setting. However, an increase of adverse arterial events was also noted in cases of asymptomatic or mild forms of COVID-19. Herein, we report a case of patient with asymptomatic SARS-CoV-2 infection, who developed a threatening lower limb ischemia. Our own clinical observation suggests that COVID-19-associated arterial thrombosis can be successfully treated by embolectomy, administration of in-hospital parenteral anticoagulation, and continuation of antithrombotic therapy with a "vascular" dose of rivaroxaban after discharge.

Telemedicine technologies in improving the effectiveness of followup monitoring of patients with lower extremity peripheral artery disease during the COVID19 pandemic.

Aim. To evaluate the effectiveness of a novel approach to followup monitoring of patients with lower extremity peripheral artery disease (PAD) using telemedicine technologies. Material and methods. The study included 175 patients (mean age, 68, 1+/-7, 7 years). Two following groups of patients were formed: the main group (n=86), which used an optimized monitoring program using telemedicine techniques, and the control group (n=89), which assumed traditional monitoring by a cardiologist and a vascular surgeon. The mean followup period was 11, 77+/-1, 5 months. The optimized monitoring program included the implementation of audio communication with patients by an employee with a secondary medical education with an assessment of the current health status according to original unified questionnaire, with the definition of personalized management tactics. At the primary and final stages, the patient underwent an assessment of clinical and anamnestic data, mental and cognitive status, and compliance. Results. At the final stage, uncompensated hypertension was revealed in 36, 0% and 49, 4% (p=0, 0001), smoking - in 30, 6% and 42, 9% (p=0, 05) in the main and control group, respectively. In the main group, a greater painfree walking distance was revealed - 625, 8+/-395, 3 m (control group - 443+/-417 m (p=0, 013)). The average systolic blood pressure was 125, 2+/-10, 2 mm Hg and 138, 8+/-15, 8 mm Hg (p=0, 0001) in the main and control group, respectively. In the control group, a greater number of patients with a high level of personal and situational anxiety were revealed (p=0, 05). In the main group, a higher level of adherence to therapy was established at the final study stage (p=0, 001). Conclusion. The optimized monitoring program for patients with limited mobility is effective and can be implemented in practical healthcare for patients with lower extremity PAD.Copyright © 2023 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.

Successful Treatment of Subclavian Artery Thrombosis by Catheter-Based Thrombus Aspiration and Thrombolytic Therapy: A Case Report

Clinical Information Patient Initials or Identifier Number: BP4****/22 Relevant Clinical History and Physical Exam: A 55 Y / Female C/C : Pain, numbness, cold sensation & weakness of left upper limb for 2 hours. Risk Factor : Hypertension, diabetes mellitus O/E : Pale, cold and absent of radial, ulnar, brachial pulse of left upper limb. Muscle power 3/5 left side. So2 86%, BP undetectable. Right upper limb were normal. BP 160/90 mm of hg, pules : 112 b/min, RR : 26/min. Body Temperature 37.5 C [Formula presented] [Formula presented] Relevant Test Results Prior to Catheterization: CBC : WBC 7450, HB % 10.8 g/dl, ESR 20mm in 1st hour, Platelets : 262000, SARS Cov2 Antigen : Negative PT 14.3 sec, INR : 1.07 APTT : 32.4 sec. blood group: O positive Serum Creatinine : 1.1 mg/dl Plasma glucose 9.7 mmmol/l HIV Ab : Negative HBs Ag : Negative Anti-HCV : Negative Urine R/E : Normal lipid profile : Cholesterol 280mg/dl Vascular duplex ultrasound of left upper limb : A dilated echogenic thrombus had blocked the left subclaviav artery lumen. Relevant Catheterization Findings: Conventional angiography with the lowest amount of contrast agent through the right femoral artery, revealed that left subclavian artery thrombosis with total occlusion distal to Left internal mammary artery. [Formula presented] [Formula presented] [Formula presented] Interventional Management Procedural Step: A5Fr MPA catheter with side holes was negotiated through a right femoral sheath and was placed in the left subclavian artery. Initially thrombus aspiration was done with Eliminate aspiration catheter (TERUMO) with no success. Then suction was done with the MPA catheter itself with partial removal of thrombus. Then a 5Fr Pigtail catheter was placed inside the thrombus and kept in situ. For residual thrombus 250,000u of Inj. Streptokinase as a thrombolytic drug was given through the Pigtail catheter as bolus over 30 min. The maintenance dose 100,000 u per hour was given over 24 hours through the Pigtail catheter via infusion pump. After 24 hours of thrombolytic therapy, her pain was reduced, the left hand became slightly warm, and distal pulses were feebly palpable. Moreover, the skin colour returned to near normal with improvement of pallor. Bleeding was well controlled at the catheter site. Doppler sounds revealed partial improvement of arterial flow. After evaluation of partial improvement, a low dose 1000 iu per hour of heparin (UFH)was infused intravenously for 24 hours. After 48 hours, repeat angiography via the inserted catheter at the site did not reveal any atherosclerotic plaque and confirm the thrombosis-dissolution. The latter practice demonstrated a good blood flowto the left upper distal limb leaving a little thrombus in the superficial palmer arch. [Formula presented] [Formula presented] [Formula presented] Conclusion(s): Catheter-based thrombus aspiration and thrombolytic therapy is primarily reserved for patients with acute viable limb ischemia. As observed in the presented case, thrombus aspiration and thrombolytic therapy is recommended to be considered as an alternative therapeutic method for patients with arterial thrombosis due to the rapid response, shorter treatment time and lower cost, compared to common and sometimes unsuccessful therapies.Copyright © 2023

Surgical treatment of acute arterial diseases in COVID-19 patients

Objective. To study the efficiency of surgical treatment of acute arterial diseases in patients with COVID-19. Material and methods. There were 85 surgeries on the great arteries between January 2021 and October 2021. Fifty-four patients underwent 67 interventions on the lower limb arteries and 15 patients underwent 18 surgeries on the upper limb arter-ies. All patients were diagnosed with COVID-19 bilateral pneumonia and positive PCR with various CT grades of lung lesion. Indication for emergency surgical treatment was critical lower limb ischemia or acute lower limb ischemia associated with thrombosis/embolism of the main arteries. Mean age of patients was 74.4±2.2 years. Results. We performed the following interventions: thrombectomy from the lower limb arteries — 44 (51.8%) patients, endarter-ectomy from superficial femoral artery — 1 (1.1%), re-canalization and balloon angioplasty of tibial arteries — 1 (1.1%), hybrid operations — 6 (7%), thrombectomy from the upper limb arteries — 18 (21.1%), aortoiliac bifurcation replacement — 1 (1.1%), surgery for bleeding from the main arteries — 14 (16.8%) patients. All patients continued postoperative anticoagulation and an-tiplatelet therapy. In 3% of cases, we decreased amputation level to the middle third of the lower leg and preserved the knee joint. In early postoperative period, 20% of patients developed distal thrombosis with irreversible ischemia of the lower extremity that required amputation at the hip level. The mortality rate amounted to 43.4%. It was mainly associated with respiratory failure and volume of lung lesion. Conclusion. Surgical treatment of arterial thrombosis/embolism or critical ischemia is effective. However, treatment may be fol-lowed by certain complications including progression of COVID-19 viral pneumonia with respiratory failure and acute respiratory distress syndrome. Therefore, these patients require an individualized approach and collegial decision-making regarding emergency surgery. © 2023, Media Sphera Publishing Group. All rights reserved.

Intra-hospital complications during SARS-CoV2 infection

Introduction: The SARS-CoV2 virus has a respiratory tropism. Although pulmonary complications are most often in the foreground, other complications affecting other organs have been observed and associated with a greater bad prognosis. The aim of this work was to report the various complications observed in patients hospitalized with COVID-19 pneumonia. Method(s): We carried out a retrospective study from the records of patients treated for pneumonia COVID-19 hospitalized between March 2020 and July 2021. Result(s): We collected 578 patients aged between 18 and 98 years old. Thoracic complications were dominated by bronchial superinfection(4.3%), pericarditis(3.3%), pneumomediastinum(1.2%) and pneumothorax(0.8%). Among the thromboembolic complications, we counted 30 pulmonary embolisms(5.2%), 7 acute limb ischemia (1.2%), 2 strokes(0.3%) and 1 venous thrombosis deep(0.1%). Cardiac arrhythmias were observed in 6% of cases. Bradycardia sinusitis was observed in 14 patients (2.4%) and first degree atrioventricular block in 4 patients (0.7%). Acute heart failure occurred in 31 patients (5.3%). Neurological disorders were observed in 23 patients with agitation (4%) and hallucinations (1%). Acute renal failure was the most common metabolic complication (20%) followed by rhabdomyolysis (28%) and cytolysis hepatic (36%). Two patients presented with diabetic ketoacidosis (0.3%). Complications cardiac, neurological and renal were associated with a worse prognosis (p=0.001) and the pulmonary complications with longer hospitalization (p=0.01). Conclusion(s): SARS-CoV2 infection is a polymorphic disease. Identification of the different complications respiratory and extra respiratory is essential for rapid multidisciplinary care.

COVID-19 and pancreatitis: A review of the potential association

Originally thought to be a respiratory pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has been shown to cause a dizzying array of symptoms, including all major organ systems of the human body. As time elapsed, new strains of the virus have emerged, validating concerns about genetic mutation. No single treatment has proven beneficial in treating the consequences, and the world has been left at the mercy of this deadly pathogen. It has been proven that COVID-19 can cause strokes, myocardial infarcts, mesenteric infarcts, acute limb ischemia, and a wide array of other symptomatology. This review aimed to evaluate whether there exists an association between COVID-19 and pancreatitis. Forty publications (34 case reports and 4 case series) were included in the review. In total, 44 cases of acute pancreatitis (38 cases of acute edematous pancreatitis and 6 cases of necrotizing pancreatitis) in COVID-19 patients without any predisposing factors have been published since January 2020. Fortunately, only 4 (9.1%) of these patients were reported to have died. Although the exact mechanism by which COVID-19 causes pancreatitis is still unclear, studies so far have reported it as a multifactorial phenomenon. COVID-19 associated pancreatic injury is thought to involve direct cellular damage via local replication of SARS-CoV-2 within pancreatic cells, as they express angiotensin-converting enzyme 2 receptors even more strongly than lung cells. Our review concludes that acute pancreatitis should be kept in the differential list of all COVID-19 patients with gastrointestinal manifestations, especially in patients with acute abdomen.Copyright © 2023, Society of Gastrointestinal Intervention.

Peculiarities of the treatment of patients with limb ischemia against the background of COVID-19

Treatment of patients with atherosclerotic lesion of the arteries of the limb is currently an relevance and largely unsolved problem. The severity of the course is aggravated by the presence of numerous risk factors and concomitant diseases, especially at present in the context of the ongoing COVID-19 pandemic. The problem of this pathology has been aggravating the relatively stable course of atherosclerosis for two years, causing increasingly rapid and severe thrombotic complications. A new coronavirus infection dictates the need to review the management of patients with cardiovascular pathology. The paper presents an overview of articles and studies devoted to the treatment of patients with both chronic and acute limb ischemia, who have had a new coronavirus infection. There is also a review of a number of articles devoted directly to COVID-19 and its impact on the human body. The search for articles was carried out on the PubMed Internet resource and affected articles published in the period from January 2020 to February 2022. It was determined that the course of limb ischemia is complicated by coagulopathic disorders and the development of systemic thrombosis provoked by COVID-19. Unfortunately, at the moment there are no approved treatment regimens and the using of anticoagulant drugs that would not only take into account the features associated with infection, but also meet the requirements of safety and efficacy. It only confirms the relevance of the problem. © 2021 Grudnaya i Serdechno-Sosudistaya Khirurgiya. All right reserved.

Acute limb ischemia secondary to vaccine-induced inmune thrombotic thrombocytopenia (VITT) after ChAdOx1 nCoV-19

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a syndrome that resembles to heparin-induced thrombocytopenia (HIT). Platelet factor 4 (PF-4) reacts to a vaccine component resulting formation of immune complex that stimulates an autoimmune reaction triggering platelet consumption causing thrombus formation and producing thrombotic events. When suspected is important to confirm for make a correct anticoagulation management to avoid complications related to unfractioned and low weight heparins use. In this report we describe a case of acute limb ischemia secondary to ChAdOx1 nCoV-19 vaccine (Astrazeneca, Cambridge, UK)Copyright © 2022

Multifactorial Benefits of Radial Access in Endovascular Interventions to Treat Peripheral Arterial Disease-Critical Limb Threatening Ischemia

Background A paradigm shift appears to be occurring with overwhelming evidence of trans-radial access (TRA) being a safe and feasible approach for peripheral interventions compared to trans-femoral access (TFA). Our study explores the additional, multifactorial benefits of TRA regarding perioperative times, radiation, contrast administration, and cost-savings for patients and hospitals during Covid era. Methods A retrospective review of all peripheral interventions were performed over two years to outline the advantages and limitations of TRA compared to TFA approach. Patient demographics, procedural time, contrast usage, and radiation dose were recorded and analyzed. Hospital discharges and bed utilization were also studied. Results Total of 170 procedures performed via radial access were evaluated and compared to a control population of n=20 femoral access procedures. Procedural success rate for all interventions was 100% with 10% of cases presenting with acute limb ischemia and 90% presenting with chronic limb ischemia. A two-fold decrease in procedural time for TRA was evident in our analysis compared to the procedures conducted via TFA (81 +/- 43 mins vs. 164 +/- 36 mins, respectively). Furthermore, contrast usage and radiation absorption in TRA procedures decreased dramatically, adding to the potential cost-saving and safety measures for the patient and hospital system. Conclusion While current TRA limitations include operator experience, length of devices, and sheath sizes, the overall benefits of TRA over traditional TFA management cannot be ignored. TRA approach is undoubtedly a safe, feasible, efficient, and cost-saving route for peripheral interventions. It is here to stay as the present and future of diagnosing and treating peripheral arterial disease.Copyright © 2023 American College of Cardiology Foundation

Evaluating Outcomes of Extracorporeal Life Support Use in Peripartum Patients: A Single Institution Experience

Background Indications and practice of extracorporeal membrane oxygenation (ECMO) use in pregnant patients are known;however, there is minimal evidence outside of meta-analysis and case series that comprehensively documents the outcomes. This study systematically evaluates the outcomes of ECMO utilization for peripartum patients in the setting of respiratory and/or cardiovascular failure. Methods All peripartum patients from 2018 to 2021 from a single center were screened to see if ECMO was initiated in the setting of cardiac, pulmonary, or combined failure. 15 patients met inclusion criteria of requiring ECMO while pregnant or up until 6 weeks postpartum. The patient demographics;operative details;ECMO registry data;critical care characteristics;adverse events per the codes for extracorporeal life support complications;and adverse outcome for maternal, fetus, and neonates were all collected. Results The cohort studied had a mean age of 30.3 years old, was racially diverse, and had few preexisting medical conditions before pregnancy. ECMO was indicated in 10/15 patients due to COVID-19 and 4/15 patients due to cardiac disease. ECMO was intended to be a bridge to recovery for 14/15 patients of which 11/14 patients recovered to discharge. The temporary ventricular decompression therapies used in VA ECMO patients were limited to the Protek Duo Right Ventricular Assist Device and TandemHeart device. No patients required transplantation or a durable mechanical device. Notable complications: 1 intrauterine fetal demise from placental malperfusion before ECMO was started;4 maternal deaths, of which 3 were related to ECMO;4 cardiac arrest events;1 limb ischemia event after ECMO cannulation;4 cannulation site hematomas;0 cannulation site hemorrhage;1 cardiac arrhythmia event;2 patients comprised all the intracranial hemorrhage events;and 2 patients comprised all the Gastrointestinal hemorrhage events. Conclusion To our knowledge;this is the first comprehensive documentation of adverse events in peripartum patients describing maternal, fetal, neonatal, and ECMO related outcomes. This data provides a standard format to evaluate risks of ECMO use in peripartum patients.Copyright © 2023 American College of Cardiology Foundation

Long-term results of surgical treatment of patients with chronic and critical lower limb ischemia depending on myocardial revascularization

Objective: to determine the efficacy and safety of preoperative selective coronary angiography and myocardial revascularization (according to indications) during long-term follow-up in patients with chronic ischemia of the lower limbs 2B–4 stage, who underwent open surgical interventions. Material and methods. From 2015 to 2018 at the Vishnevskiy National Medical Research Center of Surgery were treated 169 patients with chronic lower limb ischemia of stage 2B–4 according to the Fontaine–Pokrovsky classification. Depending on preliminary selective coronary angiography, the patients were divided into two groups: group 1 (n = 96) – surgical treatment of chronic ischemia of the lower limbs 2B–4 stage without preliminary coronary angiography;group 2 (n = 73) – surgical treatment of chronic ischemia of the lower limbs 2B–4 stage with preliminary coronary angiography and myocardial revascularization in the presence of significant lesions of the coronary arteries. Based on the coronary angiography performed by all, 60 (82.1%) patients were diagnosed with lesions of at least one coronary artery more than 50%. The study included 144 (85.2%) men and 25 (14.8%) women. In group 1, 55 (57.2%) out of 96 patients were with chronic ischemia of the lower limbs 3–4 stage, and in group 2, 42 (57.5%) out of 73. Type 2 diabetes mellitus was present in 21 (21.8%) patients in group 1, and in 18 (24.6%) in group 2. Both groups had similar clinical characteristics (p > 0.05). In the hospital and long-term follow-up periods, the primary endpoints of the study were death from major cardiovascular complications, myocardial infarction (MI), acute cerebrovascular accident (ACA), transient ischemic attack. Secondary endpoints included repeated revascularization of the myocardium or arteries of the lower extremities, amputation of the lower limb. A total of 224 operations were performed in 169 patients (1.3 operations per 1 patient): 169 – on the arteries of the lower extremities, 55 – percutaneous coronary intervention/coronary artery bypass grafting. Results. Long-term results were analyzed in 145 (85.7%) patients: 79 (54.4%) – in group 1 and 66 (45.6%) – in group 2. During the follow-up period (on average 50 ± 2 months), the total mortality from all causes was 20 (13.7%) cases. In group 1, 11 (13.9%) deaths were noted: in 6 (7.5%) – due to myocardial infarction, in 3 (3.7%) – ACA, in 1 (1.2%) – due to cancer, in 1 (1.2%) – gangrene of the lower extremities with intoxication and multiple organ failure syndrome. In group 2, 9 (13.6%) deaths were noted: in 3 (4.5%) – due to cancer, in 2 (3.0%) – ACA, in 1 (1.5%) – pulmonary embolism, in 3 (4.5%) – COVID-19. Also, in group 1 there were 3 (3.7%) myocardial infarctions and one (1.2%) ACA without a fatal outcome, while in group 2 there was only 1 (1.5%) MI. At the secondary endpoints in the long-term period, 3 (3.7%) patients underwent percutaneous coronary intervention in group 1 and 5 (7.5%) – in group 2. In 13 patients of both groups (16.4 and 19.6%), repeated surgery was performed on the arteries of the lower extremities. Additionally, in group 1, 8 (9.0%) patients underwent amputation of the lower limb, and in group 2 – in 6 (9.0%). Conclusion. Performing coronary angiography with subsequent myocardial revascularization (according to indications) in patients with chronic ischemia of the lower limbs stage 2B–4, aimed at open surgical revascularization of the arteries of the lower extremities, in the long-term period leads to a significant decrease in the frequency of fatal myocardial infarctions (p = 0.023), as well as the total number of myocardial infarctions (p = 0.021). Patients who underwent and did not undergo coronary angiography did not receive a significant difference in the long-term period in terms of death from MI and ACA (p = 0.058). Considering the above, the results of our study show the effectiveness of performing coronary angiography with subsequent myocardial revascularization, in order to reduce cardiovascular complications in the ong term. Coronary angiography can be one of the methods of screening for coronary artery disease in these patients, if it is impossible to perform non-invasive methods for detecting and visualizing myocardial ischemia. © 2022 Ministry of Health. All rights reserved.

COVID-19 and arterial thrombosis: Report of 2 cases.

The SARS-CoV-2 infection has been predominately associated with lung disease. However, emerging evidence has associated the COVID-19 infection with a hypercoagulable state. This hypercoagulable state can occur despite the use of anticoagulants and antiplatelets. In fact, it may even be the presenting symptom of COVID-19 in some patients. Thromboembolism associated with COVID-19 carries a worse prognosis and should be identified as early as possible. Therefore, we report 2 patients with arterial thrombosis in the form of limb ischemia in the setting of COVID-19.

The results of thrombectomy from the arteries of the lower extremities in patients infected with SARS-CoV-2 Omicron variant with different severity of respiratory failure.

GOAL: Analysis of the results of thrombectomy from the arteries of the lower extremities in patients with COVID-19 against the background of different severity of respiratory failure. MATERIALS AND METHODS: This retrospective, cohort, comparative study for the period from 05/01/2022 to 20/07/2022 included 305 patients with acute thrombosis of the arteries of the lower extremities against the background of the course of COVID-19 (SARS-CoV-2 Omicron variant). Depending on the type of oxygen support, 3 groups of patients were formed: group 1 (n = 168) - oxygen insufflation through nasal cannulas; group 2 (n = 92) - non-invasive lung ventilation; and group 3 (n = 45) - artificial lung ventilation. RESULTS: Myocardial infarction and ischemic stroke were not detected in the total sample. The highest number of deaths (group 1: 5.3%, n = 9; group 2: 72.8%, n = 67; group 3: 100%, n = 45; p < 0.0001), rethrombosis (group 1 : 18.4%, n = 31; group 2: 69.5%, n = 64; group 3: 91.1%, n = 41; p < 0.0001), and limb amputations (group 1: 9.5%, n = 16; group 2: 56.5%, n = 52; group 3: 91.1%, n = 41; p < 0.0001) was recorded in group 3 (ventilated) patients. CONCLUSION: In patients infected with COVID-19 and on artificial lung ventilation, a more aggressive course of the disease is noted, expressed in an increase in laboratory parameters (C-reactive protein, ferritin, interleukin-6, and D-dimer) of the degree of pneumonia (CT-4 in overwhelming number) and localization of thrombosis of the arteries of the lower extremities, mainly in the tibial arteries.

Unexpected arterial thrombosis and acute limb ischemia in a young male patient with COVID-19: A case report.

Introduction: The spread of severe acute respiratory syndrome coronavirus 2 has resulted in coronavirus disease 2019 (COVID-19) pandemic, raising significant concerns. COVID-19 can lead to thrombotic complications such as acute limb ischemia (ALI). In patients with COVID-19, thrombotic complications may increase the risk of morbidity and mortality. Presentation of case: We report the case of a 37-year-old man who presented with a 2 weeks history of right foot pain, toes blackish discoloration, and numbness. He tested positive for COVID-19 10 days prior to his presentation. Computed tomography angiography (CTA) of the lower limbs revealed near-complete occlusion of the right popliteal artery with single-vessel posterior tibial artery runoff. The patient was brought to a hybrid operating room, and diagnostic angiography confirmed the diagnosis. He underwent popliteal artery thromboembolectomy and intraoperative thrombolysis through a posterior approach. A completion angiography demonstrated a patent popliteal artery with a 2-vessels patency to the foot. His postoperative recovery was uneventful. After surgery, the popliteal, anterior tibial, and posterior tibial arteries were all palpable. The patient was discharged home on antiplatelet therapy with frequent postoperative follow-ups during the last 1 year in our outpatient clinic. Discussion: The frequency of ALI has reduced worldwide, and the hypercoagulable condition remains an infrequent cause of limb ischemia. Patients with COVID-19 have a 35%-45% thromboembolic complication rate. In many studies, the virus launches a second attack between 7 and 14 days after symptom onset, possibly causing hypercoagulability. If conservative treatment fails, various surgical methods, including thromboembolectomy, thrombolysis, and thrombosuction, can be performed to treat ALI. Conclusion: In mild ALI symptoms, unfractionated heparin can be used with vigilant follow-up. Open and endovascular procedures are currently used to treat patients with acute limb ischemia, and technological advancements continue to make interventions easier and safer.

Unilateral Limb Ischemia in a COVID-19 Patient: A Case Report.

Coronavirus disease 2019 (COVID-19) has been primarily linked to respiratory complications, including acute respiratory distress syndrome (ARDS). However, several systemic manifestations of the disease may also occur. One of the emerging complications that is being increasingly reported in the literature is the hypercoagulable and intense inflammatory state in COVID-19 patients, which leads to venous and/or arterial thrombosis, vasospasm, and ischemia. Despite the recent advances in diagnostic and treatment modalities, the diagnosis and management of vascular ischemia in this patient population remain a challenge, resulting in increased morbidity and mortality. In this case report, we highlight the etiology and potential treatment of limb ischemia in COVID-19 patients.

Acute limb ischemia secondary to vaccine-induced thrombotic thrombocytopenia.

Vaccine-associated thrombosis has previously been described in patients presenting with cerebral sinus thrombosis, deep venous thrombosis/pulmonary embolism, or mesenteric venous thrombosis. Only recently has arterial thrombosis gained attention. A new entity known as vaccine-induced thrombotic thrombocytopenia (VITT) has been associated with the coronavirus disease of 2019 (COVID-19) vaccines produced by AstraZeneca and Johnson & Johnson. We describe a case series of three patients who presented with acute limb ischemia with vaccine-associated arterial occlusions, one of whom was diagnosed with VITT.

Acute limb ischemia in COVID-19 patients despite therapeutic anticoagulation: Experience from Africa

Background: Hypercoagulability is a common complication seen in COVID-19 infection. However, arterial thrombosis such as acute limb ischemia (ALI) is far less common. Data on the incidence and nature of arterial thromboembolic complications in patients with COVID-19 is limited, originating from a few case reports and case series. Data in the African continent are very scarce. Method: This is a case series of 10 patients with COVID-19 who developed ALI while on treatment at Eka Kotebe General Hospital, Addis Ababa, Ethiopia. All patients with ALI and COVID-19 admitted between February 1, 2021, and December 31, 2021, were retrospectively identified and reviewed. COVID-19 was confirmed by RT-PCR and ALI was confirmed by Doppler ultrasound and/or computed tomography angiography in the presence of clinical suspicion. Results: A total of 3098 patients were hospitalized with confirmed COVID-19 during the study period. In a series of 10 patients, 8 (80%) males with a median age of 53.5 years were included. All except one (10%) had one or more risk factors for ALI and one had a ‘possible' case of vaccine-induced thrombotic thrombocytopenia (VITT) associated with ALI. All were admitted with severe COVID-19 and most (80%) developed ALI during hospitalization (median of seven days from admission). The median duration between COVID-19 and ALI symptom onset was 14.5 days (IQR, 11–15). The majority (60%) were taking therapeutic anticoagulation at the time of ALI onset which is the standard of care for patients with severe disease. Five (50%) were successfully revascularized (median time of 3.5 days) and the rest underwent amputation. All survived and were discharged improved. Conclusion: ALI can occur in the context of COVID-19 even while a patient is on therapeutic dose anticoagulation and in the absence of traditional risk factors. It is wise to be vigilant of this complication for timely intervention and better treatment outcomes. © 2023 The Authors