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1.
Ann Vasc Surg ; 76: 285-288, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1525691

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 , COVID-19/diagnosis , Embolectomy , Female , Humans , Ischemia/diagnostic imaging , Ischemia/physiopathology , Ischemia/therapy , Middle Aged , Regional Blood Flow , Thrombolytic Therapy , Time-to-Treatment , Treatment Outcome
2.
Ann Vasc Surg ; 76: 289-292, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1525692

ABSTRACT

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 , 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 Outcome
3.
Ann Vasc Surg ; 75: 140-143, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1340555

ABSTRACT

The incidence of venous and arterial thromboembolic complications in COVID-19 patients is significant. The vast majority of COVID-19 patients spend their quarantine at home in a self-isolation condition. The occurrence of Acute limb ischemia (ALI) is a dangerous event that needs prompt diagnosis and management with time-dependent recanalization outcomes. We present a case series of three COVID-19 patients who suffered from ALI that occurred during home self-isolation, and that were diagnosed and treated with a significant time-delay due to COVID-19 social implications.


Subject(s)
COVID-19/complications , Delayed Diagnosis , Diagnostic Errors , Ischemia/diagnostic imaging , Peripheral Arterial Disease/diagnostic imaging , Acute Disease , Aged , Aged, 80 and over , Amputation , Anticoagulants/therapeutic use , Blood Vessel Prosthesis Implantation , COVID-19/diagnosis , COVID-19/therapy , Embolectomy , Humans , Ischemia/etiology , Ischemia/surgery , Male , Peripheral Arterial Disease/etiology , Peripheral Arterial Disease/surgery , Predictive Value of Tests , Thrombectomy , Thrombolytic Therapy , Time-to-Treatment , Treatment Outcome
4.
Ann Vasc Surg ; 75: 136-139, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1210816

ABSTRACT

INTRODUCTION: The SARS-CoV-2 infection is associated with significant morbidity and mortality rates. The impact of thrombotic complications has been increasingly recognized as an important component of this disease. CASE REPORTS: We describe four cases of spontaneous acute aortic thrombosis in patients with SARS-CoV-2 infection observed from March to December 2020 at Fondazione Policlinico Universitario Gemelli IRCCS in Rome, Italy.


Subject(s)
Aortic Diseases/etiology , COVID-19/complications , Thrombosis/etiology , Acute Disease , Aged , Aortic Diseases/diagnostic imaging , Aortic Diseases/surgery , COVID-19/diagnosis , Embolectomy , Fatal Outcome , Female , Humans , Male , Thrombectomy , Thrombosis/diagnostic imaging , Thrombosis/surgery , Treatment Outcome
5.
Ann Vasc Surg ; 74: 80-87, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1163382

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes thromboembolic complications during or post-infection period despite a lack of conventional risk factors. The study aims to learn fundamental changes in COVID-19 patients who underwent embolectomy in terms of clinical characteristics and clot composition. METHODS: In a retrospective cohort study design, we evaluated 21 patients who underwent embolectomy in our clinic between March 12, 2020, and December 31, 2020. Demographics, characteristics, and laboratory values were abstracted and analyzed. Histopathological assessment was held in the pathology department. RESULTS: Of these 21 patients, 11 (52.3%) were SARS-CoV-2 positive and 10 (47.6%) were SARS-CoV-2 negative. There is no statistical difference in terms of anatomic distribution, diagnostic method, length of hospital stay, amputation or mortality levels. Thromboembolic material of COVID-19 patients include significantly less red blood cell (RBC) (21.2-32.6%; P= 0.01), more lymphocyte (14.1-2.6%; P< 0.001), and more leukocyte (27.1-22.1%; P= 0.05). There was no statistical difference between the fibrin ratio. CONCLUSIONS: Inflammatory cells are prominent in arterial thromboembolic material of COVID-19 patients. A combination of hyperinflammation and prothrombotic status may be responsible for this phenomenon.


Subject(s)
COVID-19/complications , Inflammation/pathology , Peripheral Arterial Disease/pathology , Thromboembolism/pathology , Adult , Aged , Aged, 80 and over , Amputation , COVID-19/diagnosis , COVID-19/mortality , Embolectomy , Female , Humans , Inflammation/etiology , Inflammation/mortality , Inflammation/surgery , Length of Stay , Limb Salvage , Male , Middle Aged , Peripheral Arterial Disease/etiology , Peripheral Arterial Disease/mortality , Peripheral Arterial Disease/surgery , Retrospective Studies , Risk Assessment , Risk Factors , Thromboembolism/etiology , Thromboembolism/mortality , Thromboembolism/surgery , Time Factors , Treatment Outcome
6.
Sultan Qaboos Univ Med J ; 21(1): e116-e119, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1156224

ABSTRACT

OBJECTIVES: This study aimed to discuss the different challenges faced while managing emergency vascular surgery cases during the COVID-19 pandemic and how these challenges were overcome. METHODS: This study details 14 emergency cases that were managed during a period of one month from mid-March to mid-April at Sultan Qaboos University Hospital, Muscat, Oman. The cases included acute limb ischaemia, critical limb ischaemia, type B dissection of the thoracic aorta, thoraco-abdominal aneurysm, critical internal carotid artery stenosis, trauma, infected arteriovenous forearm loop graft and thrombosed arteriovenous fistulas. RESULTS: Only one patient was confirmed to have COVID-19. Five were negative for COVID-19 while the remaining eight were not tested. Various strategies on how the vascular surgical team accommodated changes in hospital protocols and nationwide lockdown are discussed in detail. CONCLUSIONS: With the judicious use of personal protective equipment and consumable surgical and endovascular devices, communication with support services and other hospitals and implementation of triage protocols, it was possible to manage vascular surgery emergencies effectively.


Subject(s)
COVID-19/diagnosis , Emergencies , Referral and Consultation , Vascular Diseases/therapy , Vascular Surgical Procedures/methods , Adult , Aged , Aged, 80 and over , Amputation/methods , Aneurysm, Dissecting/therapy , Angioplasty/methods , Aortic Aneurysm/therapy , Arteriovenous Shunt, Surgical , COVID-19/complications , Carotid Stenosis/therapy , Disease Management , Embolectomy/methods , Female , Graft Occlusion, Vascular/complications , Graft Occlusion, Vascular/therapy , Humans , Ischemia/therapy , Lower Extremity , Male , Middle Aged , Oman , SARS-CoV-2 , Tertiary Care Centers , Upper Extremity
7.
J Card Surg ; 36(4): 1566-1568, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1059392

ABSTRACT

Acute aortic dissection and acute pulmonary embolism (PE) are life-threatening emergencies that can mimic each other at presentation. Immediate and accurate diagnosis of these scenarios is crucial to initiate the appropriate interventions. In this case report we present a 73-year-old patient, who was admitted to our Medical Center with acute type A aortic dissection. She was tested for coronavirus disease 2019 (COVID-19) infection and was found to be positive. During her admission in the COVID-19 designated intensive care unit, she diagnosed with acute PE in the main right and left pulmonary arteries. She underwent surgery that included bilateral pulmonary embolectomy and aortic dissection repair. The patient was discharged from our hospital on the ninth postoperative day without any complications. Frequency of simultaneous presentation of acute aortic dissection and acute PE is increased with a history of coagulation abnormalities as seen in patients with COVID-19.


Subject(s)
Aneurysm, Dissecting/surgery , Aortic Aneurysm/surgery , COVID-19/diagnosis , Aged , Aneurysm, Dissecting/diagnostic imaging , Aortic Aneurysm/diagnostic imaging , Computed Tomography Angiography , Embolectomy , Female , Humans , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/surgery
8.
BMJ Case Rep ; 14(1)2021 Jan 26.
Article in English | MEDLINE | ID: covidwho-1050387

ABSTRACT

Novel COVID-19 continues to intrigue medical professionals with its varied presentations. Though it affects the respiratory tract primarily, thrombogenesis has been the Achilles' heel. A 44-year-old man diagnosed with COVID-19 presented with upper limb pain at a local hospital and was found to have thrombosis of the right axillary artery. Despite a successful embolectomy at the local hospital, there was re-occlusion of the axillary artery and the limb became ischaemic. He was referred to our institution by which time the limb became gangrenous above the elbow and had to be amputated. Extensive sloughing of the nerves was also seen in the local area. Hypercoagulability presenting with various manifestations is common in COVID-19 and needs early anticoagulation. We present this asymptomatic patient who lost a limb to this COVID-19 sequelae.


Subject(s)
Amputation , Arm/surgery , Axillary Artery , COVID-19/complications , Gangrene/surgery , Ischemia/surgery , Thrombosis/complications , Adult , Arm/blood supply , Arm/pathology , Axillary Artery/surgery , Embolectomy , Gangrene/etiology , Gangrene/pathology , Humans , Ischemia/etiology , Ischemia/pathology , Male , Recurrence , SARS-CoV-2 , Thrombosis/surgery
9.
J Card Surg ; 35(11): 3173-3175, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-692492

ABSTRACT

BACKGROUND: The current coronavirus (COVID-19) pandemic is associated with severe pulmonary and cardiovascular complications. CASE PRESENTATION: This report describes a young patient with COVID-19 without any comorbidity presenting with severe cardiovascular complications, manifesting with pulmonary embolism, embolic stroke, and right heart failure. CONCLUSION: Management with short-term mechanical circulatory support, including different cannulation strategies, resulted in a successful outcome despite his critical cardiovascular status.


Subject(s)
COVID-19/complications , Extracorporeal Membrane Oxygenation , Heart Failure/therapy , Ventricular Dysfunction, Right/therapy , Adult , Embolectomy , Embolic Stroke/therapy , Embolic Stroke/virology , Heart Failure/virology , Humans , Male , Pulmonary Embolism/surgery , Pulmonary Embolism/virology , Thrombosis/therapy , Thrombosis/virology , Ventricular Dysfunction, Right/virology
10.
Am J Case Rep ; 21: e925753, 2020 Jul 29.
Article in English | MEDLINE | ID: covidwho-690362

ABSTRACT

BACKGROUND The novel COVID-19 disease caused by the SARS-CoV-2 virus is a highly infectious disease that originated in Wuhan, China, and has rapidly spread throughout the world. In addition to respiratory complications, the virus has also been implicated in damage to other organ systems as well as coagulopathy. The present report describes the first presumptive case of COVID-19-associated acute superior mesenteric artery thrombosis and acute intestinal ischemia. CASE REPORT A 55-year old man presented to the emergency department with nausea, generalized abdominal pain and diarrhea; he denied having a fever or any respiratory symptoms. Computed tomography (CT) of the abdomen and pelvis revealed bilateral pulmonary ground-glass opacities. He tested positive for SARS-CoV-2, and was treated with hydroxychloroquine, azithromycin and ceftriaxone, and was discharged home after five days of inpatient treatment. One week later, the patient returned with recurrent nausea, vomiting and worsening diffuse abdominal pain. A CT scan of the abdomen showed a 1.6-cm clot, causing high grade narrowing of the proximal superior mesenteric artery and bowel ischemia. The patient emergently underwent exploratory laparotomy, thromboembolectomy and resection of the ischemic small bowel. A post-operative complete hypercoagulable workup was unrevealing. CONCLUSIONS Despite the absence of respiratory symptoms, patients infected with SARS-CoV-2 may show atypical presentations, such as gastrointestinal symptoms. Clinicians managing patients with suspected or confirmed SARS-CoV-2 infection during the COVID-19 pandemic should monitor these patients for potential complications that may arise from this disease.


Subject(s)
Coronavirus Infections/complications , Intestines/blood supply , Ischemia/virology , Mesenteric Vascular Occlusion/virology , Pneumonia, Viral/complications , Thrombosis/virology , Abdominal Pain/etiology , Betacoronavirus , COVID-19 , Diarrhea/etiology , Embolectomy , Humans , Infarction/diagnosis , Infarction/surgery , Infarction/virology , Intestines/diagnostic imaging , Intestines/surgery , Ischemia/diagnostic imaging , Ischemia/surgery , Male , Mesenteric Artery, Superior/diagnostic imaging , Mesenteric Artery, Superior/surgery , Mesenteric Vascular Occlusion/diagnostic imaging , Mesenteric Vascular Occlusion/surgery , Middle Aged , Pandemics , SARS-CoV-2 , Thrombectomy , Thrombosis/diagnostic imaging , Thrombosis/surgery , Tomography, X-Ray Computed
11.
Br J Hosp Med (Lond) ; 81(6): 1-12, 2020 Jun 02.
Article in English | MEDLINE | ID: covidwho-614928

ABSTRACT

Pulmonary embolism remains an important cause of morbidity and mortality in the UK, particularly following the outbreak of the novel coronavirus 2019 (COVID-19), where those infected have an increased prevalence of venous thromboembolic events. The pathophysiology in COVID-19 patients is thought to relate to a thromboinflammatory state within the pulmonary vasculature, triggered by the infection, but other risk factors such as reduced mobility, prolonged immobilisation and dehydration are likely to contribute. Several societies have released comprehensive guidelines emphasising the importance of risk stratification in patients with acute pulmonary embolism. They advocate the use of clinically validated risk scores in conjunction with biochemical and imaging results. Patients with mild disease can now be managed in the outpatient setting and with newly developed therapies, such as catheter-directed thrombolysis, becoming available in more centres, treatment options for those with more severe disease are also expanding. This article presents four theoretical but realistic cases, each diagnosed with acute pulmonary embolism, but differing in levels of severity. These demonstrate how the guidelines can be applied in a clinical setting, with particular focus on risk stratification and management.


Subject(s)
Anticoagulants/therapeutic use , Embolectomy , Fibrinolytic Agents/therapeutic use , Pulmonary Embolism/therapy , Adult , Aged , Ambulatory Care/methods , Betacoronavirus , COVID-19 , Computed Tomography Angiography , Coronavirus Infections/epidemiology , Extracorporeal Membrane Oxygenation , Female , Hospitalization , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Pulmonary Embolism/complications , Pulmonary Embolism/diagnostic imaging , Risk Assessment , SARS-CoV-2 , Severity of Illness Index , Thrombolytic Therapy/methods , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Right/etiology
12.
Ann Thorac Surg ; 110(5): e403-e404, 2020 11.
Article in English | MEDLINE | ID: covidwho-133611

ABSTRACT

A cluster of pneumonia cases caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly throughout China, Europe, and the United States. The pneumonia might evolve to acute respiratory distress syndrome, requiring assisted mechanical ventilation. The prolonged immobilization combined with respiratory failure, sepsis, and dehydration might expose SARS-CoV-2 patients to increased risk of complication, including pulmonary embolism. We report a case of SARS-CoV-2 complicated by a massive pulmonary embolism in a patient who underwent successful surgical embolectomy. We believe that maintaining the same proactive attitude suggested by current European Society of Cardiology and European Respiratory Society guidelines might help in reducing morality and improving survival in SARS-COV-2 patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Embolectomy/methods , Pneumonia, Viral/complications , Pulmonary Embolism/surgery , Acute Disease , COVID-19 , Coronavirus Infections/epidemiology , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , Radiography, Thoracic , SARS-CoV-2
13.
Ann Thorac Surg ; 110(5): e409-e411, 2020 11.
Article in English | MEDLINE | ID: covidwho-72465

ABSTRACT

Acute pulmonary embolism is an uncharacteristic presentation in patients with coronavirus 2019 (COVID-19). Here we describe the case of a young woman presenting with severe pulmonary embolism, without any associated symptoms of infections. A clot in a patent foramen ovale was noted. Despite emergency surgical embolectomy, her clinical conditions continued to deteriorate. She was put on extracorporeal life support and tested positive for COVID-19. She died of multiorgan failure on day 10. COVID-19 may have a thrombogenic effect, and it may need to be considered in cases of pulmonary embolism and in the absence of any obvious risk factor.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Embolectomy/methods , Pneumonia, Viral/complications , Pulmonary Embolism/etiology , Acute Disease , COVID-19 , Coronavirus Infections/epidemiology , Echocardiography, Transesophageal , Fatal Outcome , Female , Humans , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pulmonary Embolism/diagnosis , Pulmonary Embolism/surgery , SARS-CoV-2 , Tomography, X-Ray Computed
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