ABSTRACT
The arterial revascularization procedure is still a challenging issue in Covid-19 associated limb ischemia. Herein we aimed to present a case of a 64 year-old woman with acute ischemic signs in upper extremity who was diagnosed as a probable Covid-19 case incidentally after admission. Although late admission and failed recurrent embolectomies lead to an eventful course, intra-arterial thrombolysis seemed to present a benefitable treatment option for our patient.
Subject(s)
COVID-19/complications , Ischemia/etiology , Upper Extremity/blood supply , Acute Disease , Amputation, Surgical , COVID-19/diagnosis , Embolectomy , Female , Humans , Ischemia/diagnostic imaging , Ischemia/physiopathology , Ischemia/therapy , Middle Aged , Regional Blood Flow , Thrombolytic Therapy , Time-to-Treatment , Treatment OutcomeABSTRACT
To describe the case of a young female patient, affected by Systemic Lupus Erythematous, hospitalized for severe SARS-CoV-2 infection pneumonia and presenting a treatment-resistant acute upper limb ischemia. Two days after hospital admission, the patient suffered sudden right upper limb pain associated with mild functional impairment. At physical examination, radial and ulnar pulses were absent, and no flow signal was detected at duplex ultrasound scan. Therefore, an acute limb ischemia diagnoses was posed. Despite several surgical and endovascular revascularization attempts, the patient underwent an above the elbow amputation in 10th postoperative day from first surgical embolectomy, and she died for respiratory failure 25 days after hospitalization. Our case of acute upper limb ischemia seems to confirm that clinical manifestation and fate of thrombotic disorder in COVID-19 patients could be precipitated by concomitant autoimmune diseases.
Subject(s)
COVID-19/complications , Ischemia/etiology , Lupus Erythematosus, Systemic/complications , Upper Extremity/blood supply , Acute Disease , Amputation, Surgical , COVID-19/diagnosis , COVID-19/therapy , Disease Progression , Embolectomy , Endovascular Procedures , Fatal Outcome , Female , Humans , Ischemia/diagnostic imaging , Ischemia/physiopathology , Ischemia/therapy , Lupus Erythematosus, Systemic/diagnosis , Middle Aged , Treatment OutcomeABSTRACT
The novel pandemic of coronavirus infection (COVID-19) has been linked with coagulopathy and thromboembolic events, causing limb loss and finally death. The present report describes a case of upper limb ischemia in a patient with COVID-19 infection, who lacked conventional risk factors for acute limb ischemia (ALI).mAn 83 year-old man with intraluminal thrombus and the occlusion of the axillary and brachial arteries, ceasing blood supply to the distal part of the body, was tested positive for the COVID-19 infection. The patient received therapeutic anticoagulation and underwent open thromboembolectomy, which failed to save the patient's life. The link between COVID-19 and thromboembolism remains unknown and needs further studies to be disclosed.
Subject(s)
Axillary Artery , Brachial Artery , COVID-19/complications , Ischemia/etiology , SARS-CoV-2 , Thrombosis/complications , Upper Extremity/blood supply , Acute Disease , Aged, 80 and over , COVID-19/diagnosis , Humans , Ischemia/diagnosis , Lung/diagnostic imaging , Male , Thrombosis/diagnosis , Tomography, X-Ray Computed , Ultrasonography, DopplerABSTRACT
Although novel coronavirus-2019 (COVID-19) primarily affects the respiratory system, it can affect multiple organ systems, leading to serious complications, such as acute respiratory distress syndrome (ARDS) and multiple organ failure. Nearly 20 to 55% of patients with COVID-19 experience coagulation disorders that cause high mortality in line with the severity of the clinical picture. Thromboembolism can be observed in both venous and arterial systems. The vast majority of thromboembolic events are associated with the venous system and are often observed as pulmonary embolism. Arterial thromboembolisms often involve the arteries in the lower extremities, followed by those in the upper extremities. Herein, we report a rare case of COVID-19 pneumonia whose left arm was amputated at the forearm level after arterial thromboembolism in the left upper extremity. This case report is valuable, as it is the first reported case of upper extremity arterial thromboembolism in Turkey, as well as the only case in the literature in which the patient underwent four surgical interventions and is still alive.
Subject(s)
Amputation, Surgical/methods , Brachial Artery , COVID-19 , Reoperation/methods , Thrombectomy , Thromboembolism , Upper Extremity , Aged , Brachial Artery/diagnostic imaging , Brachial Artery/pathology , COVID-19/blood , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , Computed Tomography Angiography/methods , Humans , Male , Recurrence , SARS-CoV-2/isolation & purification , Severity of Illness Index , Thrombectomy/adverse effects , Thrombectomy/methods , Thromboembolism/complications , Thromboembolism/diagnosis , Thromboembolism/etiology , Treatment Outcome , Upper Extremity/blood supply , Upper Extremity/pathology , Upper Extremity/surgeryABSTRACT
Infection with SARS-CoV-2 leading to COVID-19 induces hyperinflammatory and hypercoagulable states, resulting in arterial and venous thromboembolic events. Deep vein thrombosis (DVT) has been well reported in COVID-19 patients. While most DVTs occur in a lower extremity, involvement of the upper extremity is uncommon. In this report, we describe the first reported patient with an upper extremity DVT recurrence secondary to COVID-19 infection.
Subject(s)
COVID-19/complications , COVID-19/diagnosis , Venous Thrombosis/complications , Venous Thrombosis/diagnosis , Aged, 80 and over , Blood Coagulation Disorders/complications , Humans , Male , Neoplasm Recurrence, Local , Polymerase Chain Reaction , RNA, Viral , Recurrence , Risk Factors , Upper Extremity/blood supply , Venous Thrombosis/therapySubject(s)
Arterial Occlusive Diseases/diagnostic imaging , Brain Ischemia/diagnostic imaging , Coronavirus Infections/complications , Peripheral Arterial Disease/diagnostic imaging , Pneumonia, Viral/complications , Stroke/diagnostic imaging , Upper Extremity/blood supply , Angiography , Arterial Occlusive Diseases/virology , Betacoronavirus , Brain Ischemia/etiology , COVID-19 , Coronavirus Infections/diagnostic imaging , Humans , Male , Middle Aged , Pandemics , Peripheral Arterial Disease/virology , Pneumonia, Viral/diagnostic imaging , SARS-CoV-2 , Stroke/etiology , Tomography, X-Ray ComputedABSTRACT
Little or nothing is known about the correlation between the upper limb deep vein thrombosis (UL-DVT) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe the increased risk of UL-DVT in 3 patients with SARS-CoV-2 who require continuous positive airway pressure with a hood and the need for early adequate antithrombotic prophylaxis.