scholarly journals A COVID-19 patient with recurrent acute limb ischaemia despite two successive types of therapeutic dose anticoagulation and thrombolysis

2021 ◽  
Vol 14 (8) ◽  
pp. e245040
Author(s):  
Eva Teng ◽  
Marcelle Pignanelli ◽  
Faiza Hammad ◽  
David Wisa
Keyword(s):  
Lower Limb ◽  
Arterial Thrombosis ◽  
Distress Syndrome ◽  
Respiratory Illness ◽  
Limb Ischaemia ◽  
Heparin Infusion ◽  
Recurrent Ischaemia ◽  
Acute Limb Ischaemia ◽  
Upper Respiratory ◽  
Infusion Protocol

COVID-19 is caused by the SARS-CoV-2, and its presentation ranges from mild upper respiratory illness to critical disease including acute respiratory distress syndrome and multiorgan dysfunction. While it was initially believed to primarily target the respiratory system, numerous studies have demonstrated it to cause a hypercoagulable state that predisposes to arterial and venous thrombosis. We present a case where a patient with COVID-19 developed acute lower limb ischaemia due to arterial thrombosis in the setting of full-dose enoxaparin, followed by heparin infusion protocol. The patient developed recurrent ischaemia despite thrombolysis in addition to anticoagulation, and eventually required open thrombectomy before making a full recovery.

scholarly journals A case report of multisite arterial thrombosis in a patient with coronavirus disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Marco Angelillis ◽  
Marco De Carlo ◽  
Andrea Christou ◽  
Michele Marconi ◽  
Davide M Mocellin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Arterial Thrombosis ◽  
Leg Pain ◽  
Nasopharyngeal Swab ◽  
Limb Ischaemia ◽  
Total Occlusion ◽  
Left Common Iliac Artery ◽  
Acute Limb Ischaemia ◽  
The Right

Abstract Background A systemic coagulation dysfunction has been associated with COVID-19. In this case report, we describe a COVID-19-positive patient with multisite arterial thrombosis, presenting with acute limb ischaemia and concomitant ST-elevation myocardial infarction and oligo-symptomatic lung disease. Case summary An 83-year-old lady with history of hypertension and chronic kidney disease presented to the Emergency Department with acute-onset left leg pain, pulselessness, and partial loss of motor function. Acute limb ischaemia was diagnosed. At the same time, a routine ECG showed ST-segment elevation, diagnostic for inferior myocardial infarction. On admission, a nasopharyngeal swab was performed to assess the presence of SARS-CoV-2, as per hospital protocol during the current COVID-19 pandemic. A total-body CT angiography was performed to investigate the cause of acute limb ischaemia and to rule out aortic dissection; the examination showed a total occlusion of the left common iliac artery and a non-obstructive thrombosis of a subsegmental pulmonary artery branch in the right basal lobe. Lung CT scan confirmed a typical pattern of interstitial COVID-19 pneumonia. Coronary angiography showed a thrombotic occlusion of the proximal segment of the right coronary artery. Percutaneous coronary intervention was performed, with manual thrombectomy, followed by deployment of two stents. The patient was subsequently transferred to the operating room, where a Fogarty thrombectomy was performed. The patient was then admitted to the COVID area of our hospital. Seven hours later, the swab returned positive for COVID-19. Discussion COVID-19 can have an atypical presentation with thrombosis at multiple sites.

scholarly journals Revascularisation through the obturator foramen of lower limbs with a compromised ipsilateral groin due to infection

2020 ◽  
Vol 102 (1) ◽  
pp. 14-17
Author(s):  
G Zenunaj ◽  
L Traina ◽  
P Acciarri ◽  
C Spataro ◽  
V Gasbarro
Keyword(s):  
Lower Limb ◽  
Graft Infection ◽  
Vascular Reconstruction ◽  
Lower Limbs ◽  
Closure Device ◽  
Limb Ischaemia ◽  
Obturator Foramen ◽  
Acute Limb Ischaemia ◽  
Femoral Vessels ◽  
Autologous Grafts

IntroductionInfra-inguinal vascular reconstruction with active groin infection is a concerning issue. Using resistant grafts to infection is the most adopted approach. However, in absence of these materials in acute situations, the trans-obturator approach allows for limb revascularisation avoiding the infected site. We evaluated the effectiveness of this approach in patients who needed lower limb revascularisation with an ipsilateral groin infection.Materials and methodsA retrospective study was conducted over a four-year period.ResultsOver this period, 13 patients underwent trans-obturator reconstructions (13 external iliac–popliteal above-knee and one aortobipopliteal above-knee bypass). Seven patients had been previously revascularised and were admitted for graft infection (six infra-inguinal bypasses, one axillo-bifemoral bypass). Four presented with acute limb ischaemia, three with groin haematoma and one with a groin abscess. The remaining cases consisted of drug-addicted patients with injury of femoral vessels due to self-injection of drugs. The patients underwent reconstructions with autologous grafts which complicated early with groin haematoma. After transobturator revascularisation, the groin underwent debridement with applying vacuum-assisted wound closure device.ConclusionThe transobturator approach could be considered as a chance for lower limb revascularisation in case of ipsilateral groin infection. Moreover, avoiding the infected site allowed us to focus separately and safely on the treatment of the inguinal wound.

scholarly journals Presentation and Outcome of Acute Limb Ischaemia

2019 ◽  
Vol 14 (1) ◽  
pp. 59-61
Author(s):  
Md Humayun Kabir ◽  
Munshi Md Mojibur Rahman ◽  
AKM Musa Khan ◽  
Alamgir Rashid Chowdhury ◽  
AT Shahrier Ahmed
Keyword(s):  
Upper Limb ◽  
Lower Limb ◽  
Armed Forces ◽  
Late Presentation ◽  
Morbidity And Mortality ◽  
Military Hospital ◽  
High Morbidity ◽  
Limb Ischaemia ◽  
Acute Limb Ischaemia ◽  
Co Morbidity

Introduction: Outcome of acute limb ischaemia (ALI) is depends on the timely intervention. Delayed reperfusion of acute occlusive limb ischemia causes local and systemic serious consequences and is the main cause of morbidity and mortality in these patients. Objective: To identify the factors impeding the management and outcome of ALI in a tertiary level hospital. Materials and Methods: This cross sectional study evaluated reporting time and management of 42 patients with ALI between Jan 2016 to Jan 2018 in Combined Military Hospital Dhaka. Late presentation of ALI is defined as reporting of patient after 72 hours of symptoms. Time of presentation, Grades of ischemia, co-morbidities, morbidities and mortality were recorded. Results: During the study period, 42 patients were included, 25 female (59.5%) and 17 male (40.5%). Average age was 63 years (30 years – 87 years). 38 (90%) patients with lower limb ischaemia and 4 (10%) patients with upper limb ischaemia. 2 patients (4.7%) reported within 6 hours of symptom, 6 patients (14.3%) presented within 24 hours, 11 patients (26.3%) within 72 hours and 23 patients (54.7%) after 72 hours. On admission, 16 patients had grade III ischemia, 18 had grade IIb, 8 had grade IIa. 12 patients died (28.5%) and 19 (45%) patients had amputation. The risk factors of amputation were grade of ischemia, extremity (lower limb 45% vs. Upper limb 0%), age and co-morbidity. Conclusion: Late presentation of acute occlusive ischemia carries high morbidity and mortality. Lack of awareness and Negligence of symptoms delay the reporting time to hospital. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 59-61

scholarly journals Acute Lower Limb Ischemia Secondary to COVID-19: A Case Report

2021 ◽  
Vol 11 (6) ◽  
pp. 161-163
Author(s):  
Komal Gharsangi ◽  
Rajesh Bhawani ◽  
Nitesh Kumar
Keyword(s):  
Lower Limb ◽  
Distress Syndrome ◽  
Multiorgan Failure ◽  
Clinical Manifestations ◽  
Limb Ischemia ◽  
Respiratory Illness ◽  
Acute Limb Ischemia ◽  
Poor Clinical Outcome ◽  
Rare Manifestation ◽  
Thrombotic Complications

COVID -19 is not just a respiratory illness; it is a great masquerader with clinical manifestations from pneumonia, acute respiratory distress syndrome to endothelial dysfunction, hypercoagulability and multiorgan failure. Thrombotic complications due to Covid related coagulopathy is of concern as it further leads to poor clinical outcome in severe cases of Covid 19. Acute limb ischemia (ALI) is a rare manifestation of Covid related coagulopathy. Key words: COVID, coagulopathy, acute limb ischemia (ALI).

The impact of a focused vascular lower limb arterial duplex (F-VLAD) scan in management decisions for acute limb ischaemia

Perfusion ◽  
2016 ◽  
Vol 32 (1) ◽  
pp. 74-80
Author(s):  
Pasha Normahani ◽  
Mohammed Aslam ◽  
Nigel J Standfield ◽  
Usman Jaffer
Keyword(s):  
Decision Making ◽  
Diagnostic Accuracy ◽  
Lower Limb ◽  
Predictive Value ◽  
Duplex Ultrasound ◽  
Full Duplex ◽  
Limb Ischaemia ◽  
Acute Limb Ischaemia ◽  
Significant Difference ◽  
The Impact

Objective: To establish the diagnostic accuracy of a ‘focused vascular lower limb arterial duplex scan (F-VLAD)’ developed to facilitate rapid decision-making for acute limb ischaemia (ALI). Methods: Ten cases of ALI were identified from our patient database; clinical details, history and examination findings were extracted from the clinical notes. Original ‘full’ duplex ultrasound (DUS) pictorial reports were ‘re-formatted’ to include only anatomical segments included in the ‘F-VLAD’ scan. The series of 10 reports were emailed to 1741 vascular surgeons. Each recipient received a random mixture of full and F-VLAD scans. Participants were asked regarding next step in management and confidence in decision-making (Likert scale; 1 strongly disagree, 5 strongly agree). The cases were again sent out to the same database and respondents were asked as to the cause of ischaemia (embolic or thrombosis). Results: Eighty-one participants responded to the first survey and 43 participants to the second survey. Participants felt more confident making decisions regarding management using the full duplex report compared to the F-VLAD report (4 (3-4) vs 3 (2-4), median (IQR); p<0.001). However, there was no significant difference in diagnostic accuracy (differentiating embolus from thrombosis) when comparing the F-VLAD and full DUS reports (85.4% vs 88.3%; p=0.461). F-VLAD and ‘full’ DUS reports had comparable sensitivity (85.1% vs 86.8%), specificity (85.6% vs 89.2%),positive predictive value (PPV) (80.4% vs 81.9%) and negative predictive value (NPV) (89.2% vs 92.2%), respectively. Conclusion: The F-VLAD scan has comparable accuracy to a traditional full DUS in diagnosing the underlying aetiology of ALI. This may facilitate surgeon-performed point-of-care DUS.

scholarly journals COVID-19 Presenting as Acute Limb Ischaemia

2020 ◽  
Author(s):  
Parminder Kaur ◽  
Sahitya Posimreddy ◽  
Balraj Singh ◽  
Firas Qaqa ◽  
Habib A Habib ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Diabetic Ketoacidosis ◽  
Medical History ◽  
Health Systems ◽  
Acute Pain ◽  
Arterial Thrombosis ◽  
Unusual Presentation ◽  
Limb Ischaemia ◽  
Acute Limb Ischaemia ◽  
History Of

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic that developed in late 2019 and early 2020 has caused thousands of deaths and has had an enormous impact on our health systems and economies. Coronavirus disease 2019 (COVID-19) complications include disseminated coagulation and thrombosis, but, to the best of our knowledge, the literature to date on these manifestations has been limited. Herein, we report an unusual presentation in a 43-year-old man with a medical history of diabetes and hypertension who presented with dyspnoea and acute pain in his right leg and was found to have acute limb ischaemia and diabetic ketoacidosis. Our case adds to the literature regarding arterial thrombosis in COVID-19.

Catheter-Related Arterial Thrombosis in Neonates and Children: A Systematic Review

2018 ◽  
Vol 118 (06) ◽  
pp. 1058-1066 ◽  
Author(s):  
Mattia Rizzi ◽  
Neil Goldenberg ◽  
Mariana Bonduel ◽  
Shoshana Revel-Vilk ◽  
Ernest Amankwah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Arterial Hypertension ◽  
Arterial Thrombosis ◽  
Congenital Heart ◽  
Ductus Arteriosus ◽  
Limb Amputation ◽  
Limb Ischaemia ◽  
Acute Limb Ischaemia

AbstractCatheter-related arterial thrombosis (CAT) is increasingly recognized in children. Available data are scarce and based on expert opinions. This systematic review aimed to identify knowledge on paediatric CAT. Among 3,484 publications, 22 met inclusion criteria. Fourteen reported on CAT due to umbilical arterial catheter (UAC), two to extremity indwelling catheter (EIC), one to both and five to cardiac catheter (CC). The overall cumulative incidence of CAT was 21% (95% confidence interval [CI], 13–31) with a relative incidence of 20% (95% CI, 10–33) for UAC and 11% (95% CI, 3–21) for CC-related CAT. The incidence of EIC-related CAT ranged from 3.4 to 63%. Clinical presentation of CAT included symptoms of acute limb ischaemia (79%, 95% CI, 54–97), arterial hypertension (55%, 95% CI, 23–86) and congestive heart failure (28%, 95% CI, 7–53). Underlying conditions of UAC-related CAT included prematurity (70%, 95% CI, 31–98), respiratory distress syndrome (56%, 95% CI, 46–65), asphyxia (41%, 95% CI, 15–69), infection (32%, 95% CI, 13–55), persistent ductus arteriosus (28%, 95% CI, 13–45), meconium aspiration (16%, 95% CI, 8–25) and congenital heart disease (9%, 95% CI, 2–19). Congenital heart disease was the likely condition in EIC- and CC-related CAT. Antithrombotic treatment included thrombolysis (71%, 95% CI, 47–91), heparin (70%, 95% CI, 41–94) and thrombectomy (46%, 95% CI, 10–95) alone or in combination. Complete resolution rate of CAT was 82% (95% CI, 65–96). Long-term complications included arterial hypertension (26%, 95% CI, 0–66) and limb amputation (12%, 95% CI, 1–31). The overall all-cause mortality rate was 7% (95% CI, 2–14). In conclusion, CAT occurs at an increased incidence in neonates and children and is potentially associated with poor outcome. However, limited data are available on paediatric CAT. This systematic review identifies the rationale for further studies on CAT in paediatric patients.

External iliac artery thrombosis: an unusual complication of femoral venous catheterisation in a neonate

2021 ◽  
Vol 14 (4) ◽  
pp. e240099
Author(s):  
Anvesh Amiti ◽  
Thangaraj Abiramalatha ◽  
Makkathai Kanakasabai Ayyappan ◽  
Usha Devi Rajendran
Keyword(s):  
Iliac Artery ◽  
External Iliac Artery ◽  
Venous Catheter ◽  
Clinical Feature ◽  
Unusual Complication ◽  
Limb Ischaemia ◽  
Heparin Infusion ◽  
Artery Thrombosis ◽  
Tibial Arteries ◽  
Acute Limb Ischaemia

We report a neonate who developed external iliac artery thrombosis after insertion of femoral venous catheter, without an apparent arterial puncture during the procedure. The baby developed acute limb ischaemia. As there was no improvement despite heparin infusion for 24 hours, thrombectomy was done. Following surgery, the limb perfusion improved gradually in 1 week. However, pulses did not reappear even after antithrombotic therapy for 3 months. There was residual Doppler abnormality in the form of severe narrowing at the origin of superficial femoral artery with reduced flow velocity in superficial femoral, popliteal and tibial arteries. The baby was kept under regular follow-up, with a plan for clinical assessment and Doppler every 6 months and to perform a vascular reconstructive surgery if he develops any clinical feature of chronic limb ischaemia. The baby is now 1 year of age. He is walking normally and there is no limb length discrepancy.

scholarly journals Outcome and complications after intra-arterial thrombolysis for lower limb ischaemia with or without continuous heparin infusion

2014 ◽  
Vol 101 (9) ◽  
pp. 1105-1112 ◽  
Author(s):  
O. Grip ◽  
M. Kuoppala ◽  
S. Acosta ◽  
A. Wanhainen ◽  
J. Åkeson ◽  
...  
Keyword(s):  
Lower Limb ◽  
Limb Ischaemia ◽  
Heparin Infusion ◽  
Lower Limb Ischaemia ◽  
Arterial Thrombolysis

scholarly journals Thrombolysis for acute graft occlusion during elective endovascular aortic aneurysm repair

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
Jared M Wohlgemut ◽  
Martin Hennessy ◽  
Keith Hussey
Keyword(s):  
Lower Limb ◽  
Arterial Thrombosis ◽  
Endovascular Aneurysm Repair ◽  
Limb Ischaemia ◽  
Graft Occlusion ◽  
Pharmacological Management ◽  
Mechanical Disruption ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair ◽  
Arterial Thrombolysis

Abstract A 65-year-old man developed acute arterial thrombosis with stent graft occlusion, during elective endovascular aneurysm repair, with bilateral acute lower limb ischaemia. We describe successful endovascular and pharmacological management using a combination of mechanical disruption of the thrombus (using the access sheaths) followed by intra-arterial thrombolysis (Actilyse) infusion. Within 4-h the endograft had completely re-canalized. The patient made an uncomplicated recovery and was discharged on the second post-operative day.

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