Acute Limb Ischemia Due to Arterial Thrombosis Associated With Coronavirus Disease 2019

COVID-19(Corona virus disease 2019), which starts from Wuhan, China on December, 2019 spread rapidly to different countries of the world including Bangladesh. It affects huge impact on health care system. It’s a new disease with multisystem involvement. Physicians are experiencing new presentation of different cases and rare complication including arterial thrombosis. Few data is available regarding arterial thrombosis in SARS-CoV-2 infected patients. We are currently fighting with a 60 year old lady suffering from COVID-19 pneumonia with other co-morbidities developed severe arterial occlusion of right leg despite of taking anti platelet for long time for another cause. Patient developed irreversible right lower limb ischemia not improving with continuous infusion of unfractionated heparin followed by severe pulmonary embolism. So further study and recommendations will need to evaluate the cases and treatment in COVID-19 Patients with rare presentation. Bangladesh Journal of Infectious Diseases, October 2020;7(suppl_2):S50-S56

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Unexpected arterial thrombosis and acute limb ischemia in COVID-19 patients. Results from the Ibero-Latin American acute arterial thrombosis registry in COVID-19: (ARTICO-19)

Vascular ◽

10.1177/17085381211052033 ◽

2021 ◽

pp. 170853812110520

Author(s):

Mauricio Gonzalez-Urquijo ◽

Jose Manuel Gonzalez-Rayas ◽

Alejandra Castro-Varela ◽

David E Hinojosa-Gonzalez ◽

Ray Erick Ramos-Cazares ◽

...

Keyword(s):

Surgical Management ◽

Latin American ◽

Arterial Thrombosis ◽

Health Workers ◽

Limb Ischemia ◽

Multivariate Regression Analysis ◽

Acute Ischemia ◽

Initial Symptom ◽

Acute Limb Ischemia ◽

Surgical Interventions

Objective Few studies have focused on arterial thrombosis and acute limb ischemia in COVID-19. This international registry intended to study the spectrum of clinical characteristics, therapeutic trends, and outcomes in a cohort of Ibero-Latin American patients with arterial thrombosis or acute limb ischemia and COVID-19. Methods Data were retrospectively obtained from 21 centers in 9 countries. Patients with proven COVID-19 and asymptomatic or symptomatic arterial thrombosis were included. COVID-19 diagnosis was established by RT-PCR assay or IgM serology plus suggestive clinical/radiographical findings. We recorded and analyzed variables related to demography, clinical presentation, therapeutic trends, and outcomes. Results Eighty one patients were included in the registry. In 38.3%, acute limb ischemia symptoms were the first manifestation of COVID-19. Non-surgical management was more frequent in severe cases than surgical interventions, 11.1% vs. 88.9%, respectively ( p = 0.004). Amputation rates were similar between all COVID severity groups ( p = 0.807). Treatment was classified as non-surgical, open surgical, and endovascular treatment. Further analysis revealed an equal frequency of major leg amputation between treatment groups and increased mortality in patients with non-surgical management. However, multivariate regression analysis showed that treatment choices are associated with disease severity, with significant non-surgical treatment in critical patients; thus, mortality is related to the severity and confounds treatment analysis. Conclusion Arterial thrombosis can be the initial symptom of a patient presenting with COVID-19. Physicians and health workers should potentially suspect COVID-19 in acute ischemia cases without a known risk factor or embolic cause. More experimental and clinical research is required to understand the complex phenomenon of arterial COVID-19 induced coagulopathy fully.

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Acute arterial ischemia in COVID-19

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.210022 ◽

2021 ◽

Vol 20 ◽

Author(s):

Silvia Maqueda Ara ◽

Marta Ballesteros Pomar ◽

Nuria Sanz Pastor ◽

Cristina Nogal Arias ◽

Marcos Del Barrio Fernández

Keyword(s):

Arterial Thrombosis ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

The Novel ◽

Surgical Revascularization ◽

Prognosis Factor ◽

Coronavirus Infection ◽

Poor Outcomes ◽

Novel Coronavirus ◽

D Dimer

Abstract Since the coronavirus pandemic set in in Spain in March 2020, a noteworthy increase in the incidence of acute limb ischemia (ALI) has been observed. It has been recently discovered that SARS-CoV 2 may lead to ALI secondary to arterial thrombosis. Elevation of D-dimer (DD) in patients with coronavirus infection (COVID-19) indicates that a hypercoagulable state causes acute arterial thrombosis. A remarkably high DD elevation has been reported to be a poor prognosis factor in COVID-19. The ways in which SARS-CoV 2 results in arterial thrombosis may be multiple. On the other hand, surgical revascularization for ALI is associated with poor outcomes in COVID-19 patients, probably in relation to hypercoagulability. Here, we describe two ALI cases in patients who required urgent surgical treatment for limb salvage and were positive for the novel coronavirus infection (COVID 19).

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Balloon-Assisted Ultrasound-Guided Percutaneous Thrombin Injection of Iatrogenic Femoral Artery Pseudoaneurysms: A Case Report and Description of the Technique

Vascular and Endovascular Surgery ◽

10.1177/1538574420927861 ◽

2020 ◽

Vol 54 (6) ◽

pp. 532-535

Author(s):

Travis J. Vowels ◽

M. Mujeeb Zubair ◽

Jean Bismuth ◽

Linda Le

Keyword(s):

Femoral Artery ◽

Arterial Thrombosis ◽

Wound Dehiscence ◽

Limb Ischemia ◽

Invasive Technique ◽

Morbidly Obese ◽

Acute Limb Ischemia ◽

Thrombin Injection ◽

Ultrasound Guided ◽

Percutaneous Thrombin Injection

Ultrasound-guided thrombin injection (UGTI) has emerged as the first-line treatment for moderately sized or persistent pseudoaneurysms (PSAs). Although rare, the most feared complication of UGTI is arterial thrombosis or embolism during the off-label injection of thrombin causing acute limb ischemia requiring emergent surgical intervention. Higher thrombin volume, rapidity of injection, and wide or short-neck PSAs are all thought to increase the risk of arterial thrombosis or embolism during this procedure. For patients with unfavorable PSA anatomy who are high-risk surgical candidates due to their medical comorbidities or active critical illness, balloon-assisted thrombin injection (BATI) has been suggested as a means to potentially reduce the risk of thrombosis or distal embolization associated with UGTI. This minimally invasive technique also decreases the risk of groin wound dehiscence or infection associated with open repair, especially in patients who are morbidly obese or have had prior groin surgery. We report a patient with a complex femoral artery PSA after endovascular intervention who was successfully treated with BATI and describe the procedure in detail.

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Left Subclavian Arterial Thrombosis Presenting as Acute Limb Ischemia in a Coronavirus Disease 2019 Patient – An Extreme Rarity

Research in Cardiovascular Medicine ◽

10.4103/rcm.rcm_24_20 ◽

2020 ◽

Vol 9 (4) ◽

pp. 100

Author(s):

AkshayAshok Bafna ◽

Meenakshi Gajbiye ◽

Kishore Deore ◽

Swenil Shah ◽

Varun Bafna

Keyword(s):

Arterial Thrombosis ◽

Limb Ischemia ◽

Acute Limb Ischemia

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Management of COVID-19-related Arterial Thrombosis Leading to Acute Limb-threatening Ischemia

10.1101/2021.03.20.21252888 ◽

2021 ◽

Author(s):

waqas raza ◽

omer ehsan

Keyword(s):

Critical Limb Ischemia ◽

Arterial Thrombosis ◽

Clinical Evidence ◽

Initial Period ◽

Case Series ◽

Limb Ischemia ◽

Vascular Involvement ◽

Low Molecular Weight ◽

Acute Limb Ischemia ◽

Patient Groups

Objective: Examine the occurrence and clinical outcomes of arterial thrombosis leading to limb- threatening ischemia in patients with coronavirus-2019 (COVID-19). Study design: Prospective, descriptive case series. Patients and Methods: Forty-four patients with COVID-19 infection presenting with critical limb ischemia were managed between March 2020 and December 2020. The patients were divided into three groups based on the mode of presentation: 1) those who had been admitted; 2) those presenting in the emergency department; and 3) those presenting to vascular clinics. Clinical evidence suggesting limb ischemia was evaluated with computerized tomographic angiogram. Vascular care was designed according to the need of individual patients, through anticoagulation, revascularization by thrombo-embolectomy, or bypass grafting and amputation. Results: Ten major amputations and 4 deaths (all in patients admitted) occurred among the 44 patients (9.1%). Most patients (32/44) were males, mean age was 55, and limb ischemia occurred among patients as young as 29. The initial period of ischemia was often not appreciated by patients and physicians. Critical limb ischemia was often not correlated with the severity of COVD symptoms: of 17 patients who presented through the emergency room with limb-threatening ischemia, 10 (58.9%) were asymptomatic for respiratory and general symptoms. Comorbidities were common among all 3 patient groups (26/44; 59%). Anticoagulants did not consistently prevent thromboembolic events since all admitted patients were receiving low molecular weight heparin. The rate of revascularization was lower in this population than in the general population with similar limb ischemia. Conclusion: Acute limb ischemia in patients with COVID-19 is a vascular emergency that can result in limb loss and even death. The severity of respiratory infection and other symptoms of COVID often are not consistent with the severity and level of vascular involvement. Timely recognition and tailored intervention is needed to save limbs in this population.

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Arterial Thrombosis and Acute Limb Ischemia as a Complication of COVID-19 Infection

The American Surgeon ◽

10.1177/00031348211023416 ◽

2021 ◽

pp. 000313482110234

Author(s):

Vladimir Y. Khryshchanovich ◽

Nicolay A. Rogovoy ◽

Evgeniy V. Nelipovich

Keyword(s):

Arterial Thrombosis ◽

Respiratory Infections ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Predisposing Factor ◽

Critical Ill Patients ◽

High Incidence ◽

Peripheral Arterial ◽

Viral Respiratory Infections ◽

Viral Respiratory

COVID-19 refers to viral respiratory infections and is the predisposing factor for the development of venous and arterial thrombotic events due to a pronounced inflammatory response, platelet activation, endothelial dysfunction, and stasis. Recent studies have confirmed a high incidence of thromboembolic events, especially in the group of patients with severe coronavirus pneumonia. There have been an increasing number of reports of peripheral arterial thrombosis as well. Most cases of arterial thrombosis are noted in critical ill patients in intensive care setting. However, an increase of adverse arterial events was also noted in cases of asymptomatic or mild forms of COVID-19. Herein, we report a case of patient with asymptomatic SARS-CoV-2 infection, who developed a threatening lower limb ischemia. Our own clinical observation suggests that COVID-19-associated arterial thrombosis can be successfully treated by embolectomy, administration of in-hospital parenteral anticoagulation, and continuation of antithrombotic therapy with a “vascular” dose of rivaroxaban after discharge.

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Percutaneous Revascularization for COVID-19 Induced Spontaneous Arterial Thrombosis

Vascular and Endovascular Surgery ◽

10.1177/15385744211010445 ◽

2021 ◽

pp. 153857442110104

Author(s):

Margaret Aasen ◽

Matthew Blecha

Keyword(s):

Limb Salvage ◽

Arterial Thrombosis ◽

Management Strategy ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Optimal Management ◽

Tibial Arteries ◽

Complete Thrombosis ◽

Percutaneous Revascularization ◽

Ventilated Patients

The optimal management strategy of acute limb ischemia in non-ventilated patients with COVID-19 is uncertain. We propose that non-ventilated patients who develop COVID-19 related spontaneous arterial thrombosis with associated limb threat may be best suited with percutnaeous revascularization to achieve limb salvage. Herein we describe 5 cases of patients who had severely threatened limbs with complete thrombosis of all 3 tibial arteries who were treated with percutaneous revascularization. All 5 patients were felt to be facing inevitable amputation without revascularization should they survive their COVID hospitalization. We were able to achieve limb salvage in all 5 patients selected for therapy, although 2 ultimately succumbed to respiratory failure.

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Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽

10.1024/0301-1526/a000876 ◽

2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Marina Di Pilla ◽

Stefano Barco ◽

Clara Sacco ◽

Giovanni Barosi ◽

Corrado Lodigiani

Keyword(s):

Systematic Review ◽

Case Report ◽

Lower Limb ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Review Of The Literature ◽

Heparin Induced Thrombocytopenia ◽

Lower Limb Ischemia ◽

Vein Thrombosis ◽

Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

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