Treatment-Resistant Acute Upper Limb Ischemia in a Patient With Systemic Lupus Erythematous and Concomitant SARS-CoV-2 Infection: A Case Report.

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.

Colon ischemia following abdominal aortic aneurysm repair in the era of endovascular abdominal aortic repair.

OBJECTIVE: To review, in the era of endovascular abdominal aortic repair (EVAR), the clinical spectrum of colonic ischemia (CI) following abdominal aortic aneurysm (AAA) repair and to assess the rate, overall mortality, and associated factors of occurrence. METHODS: Between 1995 and 2005, 1174 patients with infrarenal AAA were treated either by open surgery (n = 682) or by EVAR (n = 492). Preoperative risk factors, clinical presentation, intraoperative data, and early postoperative outcomes were prospectively assessed. Overt colonic ischemia as proven by colonoscopy and/or by operation was considered as a validating event and was correlated to collected variables. RESULTS: CI occurred in 34 patients (2.9%). Eighteen out of 34 (53%) patients died within 1 month. At 2 years, the survival rate was 35% in the CI group vs 86% in the non-CI group. Associated factors of occurrence of CI were: type of operation (open group = 27/682 [4%] vs EVAR = 7/492 [1.4%] [P = .01]), aneurysm rupture (11/88 [12.5%] vs 23/1086 [2.1%], P < .001), preoperative renal insufficiency (4/30 [13.3%] vs 29/1133 [3.1%], P = .01), preoperative respiratory insufficiency (8/157 [7%] vs 23/1005 [2%], P = .01), duration of operation (<2 hours [518] = 1.7%, between 2 to 4 hours [558] 2.9%, more than 4 hours [66] 13.6%, P = .001). Mean blood loss was greater in patients with CI (CI = 2000 ml [650-3350] than in those without CI = 1000 ml [500-1800] P = .008). Logistic regression analysis showed that rupture (OR 6.03 [interval of confidence (IC) 95% 2.68-13.5] P = .0001), duration of operation (OR 5.73 [IC 95% 2.06-15.9] P = .001) and creatinin > 200 mol/l (OR 4.67 [IC 95% 1.39-15.7] P = .028) were independent factors of CI. The mortality due to colonic ischemia was not statistically different between open surgery 14/27 (52%) and EVAR 4/7 (57%). CONCLUSION: CI remains a serious complication following AAA repair. In the univariate analysis, EVAR was associated with a lower rate of colonic ischemia. However, the logistic regression analysis showed that only rupture, long duration of operation, and prior renal disease were independently associated with CI. Within the two treatment modalities, the mortality rate remained identical.