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1.
J Vasc Surg ; 77(4): 1165-1173.e1, 2023 Apr.
Article in English | MEDLINE | ID: covidwho-2237126

ABSTRACT

OBJECTIVE: Hypercoagulability is common in severe acute respiratory syndrome coronavirus 2 and has been associated with arterial thrombosis leading to acute limb ischemia (ALI). Our objective was to determine the outcomes of concurrent coronavirus disease 2019 (COVID-19) infection and ALI, particularly during the Delta variant surge and the impact of vaccination status. METHODS: A retrospective review was performed of patients treated at a single health care system between March 2020 and December 2021 for ALI and recent (<14 days) COVID-19 infection or who developed ALI during hospitalization for the same disease. Patients were grouped by year as well as by pre and post Delta variant emergence in 2021 based on the World Health Organization timeline (January to May vs June to December). Baseline demographics, imaging, interventions, and outcomes were evaluated. A control cohort of all patients with ALI requiring surgical intervention for a 2-year period prior to the pandemic was used for comparison. Primary outcomes were in-hospital mortality and amputation-free survival. Kaplan-Meier survival and Cox proportional hazards analysis were performed. RESULTS: Forty acutely ischemic limbs were identified in 36 patients with COVID-19, the majority during the Delta surge (52.8%) and after the wide availability of vaccines. The rate of COVID-19-associated ALI, although low overall, nearly doubled during the Delta surge (0.37% vs 0.20%; P = .09). Intervention (open or endovascular revascularization vs primary amputation) was performed on 31 limbs in 28 individuals, with the remaining eight treated with systemic anti-coagulation. Postoperative mortality was 48%, and overall mortality was 50%. Major amputation following revascularization was significantly higher with COVID-19 ALI (25% vs 3%; P = .006) compared with the pre-pandemic group. Thirty-day amputation-free survival was significantly lower (log-rank P < .001). COVID-19 infection (adjusted hazard ratio, 6.2; P < .001) and age (hazard ratio, 1.1; P = .006) were associated with 30-day amputation in multivariate analysis. Severity of COVID-19 infection, defined as vasopressor usage, was not associated with post-revascularization amputation. There was a higher incidence of re-thrombosis in the latter half of 2021 with the Delta surge, as reintervention for recurrent ischemia of the same limb was more common than our previous experience (21% vs 0%; P = .55). COVID-19-associated limb ischemia occurred almost exclusively in non-vaccinated patients (92%). CONCLUSIONS: ALI observed with Delta appears more resistant to standard therapy. Unvaccinated status correlated highly with ALI occurrence in the setting of COVID-19 infection. Information of limb loss as a COVID-19 complication among non-vaccinated patients may help to increase compliance.


Subject(s)
COVID-19 Vaccines , COVID-19 , Endovascular Procedures , Peripheral Arterial Disease , Humans , COVID-19/complications , Endovascular Procedures/adverse effects , Ischemia/diagnostic imaging , Ischemia/etiology , Ischemia/therapy , Limb Salvage , Lower Extremity/blood supply , Retrospective Studies , Risk Factors , SARS-CoV-2 , Treatment Outcome , Vaccines , COVID-19 Vaccines/adverse effects
3.
Vasc Endovascular Surg ; 55(2): 196-199, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-760502

ABSTRACT

COVID-19 has to date affected over 5 million people worldwide and caused in excess of 300000 deaths. One of the principal finding is that of a thrombotic tendency within the lungs leading to high mortality. There have been increasing number of reports of peripheral arterial thrombosis as well. Most cases of arterial thrombosis is noted in patient in intensive care setting. Here-in we report a case of acute bilateral lower limb arterial thrombosis in a patient recovering at home with mild COVID-19 symptoms, highlighting that patients with milder symptoms may also suffer from prothrombotic state resulting in acute arterial occlusions. Arterial thrombosis should be suspected in these patients despite the absence of predisposing factors.


Subject(s)
Arterial Occlusive Diseases/virology , COVID-19/complications , Ischemia/virology , Lower Extremity/blood supply , Thrombosis/virology , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/therapy , COVID-19/diagnostic imaging , COVID-19/therapy , Humans , Ischemia/diagnostic imaging , Ischemia/therapy , Male , Middle Aged , Thrombosis/diagnostic imaging , Thrombosis/therapy
4.
Ann Vasc Surg ; 70: 314-317, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-739734

ABSTRACT

Thrombotic complications associated with coronavirus disease 2019 (COVID-19) have been described; these have mainly included venous thromboembolic events. Limited literature is available regarding arterial thrombosis. Acute limb ischemia is associated with severe complications that can result in significant morbidity and mortality. Herein, we report 3 cases of COVID-19 infection complicated by arterial thrombosis in the form of acute limb ischemia. Our case series adds to the limited literature regarding arterial thrombosis.


Subject(s)
Arterial Occlusive Diseases/etiology , COVID-19/complications , Ischemia/etiology , Lower Extremity/blood supply , Thrombosis/etiology , Aged , Anticoagulants/therapeutic use , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/therapy , COVID-19/diagnosis , COVID-19/therapy , Fatal Outcome , Female , Humans , Ischemia/diagnostic imaging , Ischemia/therapy , Male , Palliative Care , Thrombolytic Therapy , Thrombosis/diagnostic imaging , Thrombosis/therapy , Treatment Outcome , Vascular Surgical Procedures
5.
Ann Vasc Surg ; 69: 80-84, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-703963

ABSTRACT

Novel 2019 coronavirus (COVID-19) infection usually causes a respiratory disease that may vary in severity from mild symptoms to severe pneumonia with multiple organ failure. Coagulation abnormalities are frequent, and reports suggest that COVID-19 may predispose to venous and arterial thrombotic complications. We report a case of acute lower limb ischemia and resistance to heparin as the onset of COVID-19 disease, preceding the development of respiratory failure. This case highlights that the shift of coagulation profile toward hypercoagulability was associated with the acute ischemic event and influenced the therapy.


Subject(s)
Coronavirus Infections/diagnosis , Ischemia/diagnosis , Ischemia/therapy , Lower Extremity/blood supply , Pneumonia, Viral/diagnosis , Acute Disease , Anticoagulants/administration & dosage , Betacoronavirus , Biomarkers/blood , COVID-19 , Diagnosis, Differential , Diagnostic Imaging , Heparin/administration & dosage , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Thrombectomy , Thrombophilia/complications , Thrombophilia/drug therapy
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