ABSTRACT
Investigations have shown that infection from the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is responsible also for initiating severe inflammatory responses that can lead macrovascular and microvascular thrombosis. Several studies have already described acute limb ischemia and peripheral arterial disease in critically ill patients with Coronavirus disease 2019 (Covid-19), as well as coronary artery disease and ischemic stroke as a manifestation usually associated with respiratory distress. However, what still remains unclear is how long inflammation and thrombotic derangements can last after recovery from the symptoms of Covid-19. Hence, in this article we report 3 cases of arterial thrombotic sequalae after this viral infection. To the best of our knowledge, this is the first cases' series that had described different delayed vascular arterial complications, which occurred after the index infection, with a negative nasopharyngeal swab and Covid-19 systemic symptoms resumption. A better understanding of the coagulopathy in Covid-19 could have an essential role to guide prevention and treatment of arterial thromboembolic events, both during and after the viral infection. Further investigations are required to confirm these data and to estabilish the type, dose and duration of anticoagulant/antiplatelet therapy not just during but also after Covid-19 infection.
Subject(s)
Arterial Occlusive Diseases/etiology , COVID-19/complications , Thrombosis/etiology , Aged , Anticoagulants/therapeutic use , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/drug therapy , COVID-19/diagnosis , COVID-19/therapy , Female , Fibrinolytic Agents/therapeutic use , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Risk Factors , Thrombolytic Therapy , Thrombosis/diagnostic imaging , Thrombosis/drug therapy , Time Factors , Treatment OutcomeSubject(s)
Arterial Occlusive Diseases/drug therapy , Betacoronavirus , Coronavirus Infections/complications , Extracorporeal Membrane Oxygenation , Fibrinolytic Agents/therapeutic use , Heparin/therapeutic use , Pandemics , Pneumonia, Viral/complications , Pulmonary Artery , Thrombolytic Therapy/methods , Thrombosis/drug therapy , Tissue Plasminogen Activator/therapeutic use , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , Asthma/complications , COVID-19 , Catheterization , Computed Tomography Angiography , Coronavirus Infections/blood , Fibrin Fibrinogen Degradation Products/analysis , Fibrinolytic Agents/administration & dosage , Heparin/administration & dosage , Humans , Lung/blood supply , Lung/diagnostic imaging , Natriuretic Peptide, Brain/blood , Pneumonia, Viral/blood , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/pathology , Respiration, Artificial , SARS-CoV-2 , Thrombolytic Therapy/instrumentation , Thrombosis/diagnostic imaging , Thrombosis/etiology , Tissue Plasminogen Activator/administration & dosage , Ventricular Dysfunction, Right/etiologyABSTRACT
SARS-CoV-2 (COVID-19) patients with associated thromboembolic events have demonstrated poor outcomes despite the use of anticoagulation therapy and surgical intervention. We present a COVID-19 patient with acute limb ischemia, secondary to extensive thrombosis of an aortic aneurysm, iliac arteries, and infrainguinal arteries. Initial treatment with systemic thrombolysis, which restored patency of the aortoiliac occlusion, was followed by open thrombectomies of the infrainguinal occlusions.