Acute Lower Limb Ischemia in COVID-19 Patient with Delayed Presentation

Thromboembolism is a common complication of SARS-CoV-2, which generally involves venous thromboembolism, although there have been reported cases of arterial thrombosis affecting cerebral, coronary, and visceral arteries, as well as arteries in the extremities. We discuss a case of a 45-year-old diabetic man with COVID-19 who developed late-onset acute lower limb ischemia.

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COVID vaccine related lower limb gangrene: the first case report

International Surgery Journal ◽

10.18203/2349-2902.isj20214026 ◽

2021 ◽

Vol 8 (10) ◽

pp. 3204

Author(s):

Nishant Lal ◽

Shafy Ali Khan ◽

Aiswarya R. Pillai ◽

Shafy Ali Khan

Keyword(s):

Case Report ◽

Lower Limb ◽

Arterial Thrombosis ◽

Clinical Symptoms ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

First Case ◽

Symptoms And Signs

Though there have been multiple cases of arterial thrombosis and gangrene of limbs reported following COVID-19 infections, there has not been any case reported following COVID-19 vaccinations. Here we reported a case of acute lower limb ischemia following COVID-19 vaccination in a 32 year male with no co-morbidities. The clinical symptoms and signs related to lower limb ischemia started 2 weeks after COVID-19 vaccination. Despite anticoagulation, thrombo embolectomy and intraluminal catheter guided thrombolysis, patient’s left forefoot became gangrenous and had to be amputated.

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Lower-Limb Ischemia at Birth Because of Spontaneous Arterial Thrombosis

JBJS Case Connector ◽

10.2106/jbjs.cc.20.00643 ◽

2021 ◽

Vol 11 (3) ◽

Author(s):

Sandeep V. Vaidya ◽

Deepika A. Pinto ◽

Rujuta Mehta ◽

Mandar V. Agashe ◽

Alaric Aroojis

Keyword(s):

Lower Limb ◽

Arterial Thrombosis ◽

Limb Ischemia ◽

Lower Limb Ischemia

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Transient Hemi-Lower Limb Ischemia in the Newborn: Arterial Thrombosis or Persistent Sciatic Artery?

American Journal of Perinatology Reports ◽

10.1055/s-0037-1598044 ◽

2017 ◽

Vol 07 (01) ◽

pp. e13-e16

Author(s):

Makiko Kirino ◽

Masayuki Ochiai ◽

Masako Ichiyama ◽

Hirosuke Inoue ◽

Takeshi Kusuda ◽

...

Keyword(s):

Lower Limb ◽

Arterial Thrombosis ◽

Vascular Anomaly ◽

Limb Ischemia ◽

Therapeutic Interventions ◽

Lower Limb Ischemia ◽

Persistent Sciatic Artery ◽

Contrast Enhanced ◽

Ischemic Episode ◽

Enhanced Computed Tomography

Neonatal thromboembolism occurs with various predispositions and triggers. Early diagnosis of the thrombosis is challenging and essential for the therapeutic interventions. We herein report two newborns who presented with transient hemi-lower limb ischemia due to (1) arterial thrombosis or (2) a persistent sciatic artery (PSA). The patient with arterial thrombosis showed elevations of fibrin degradation product and D-dimer and received antithrombin and heparin intravenously. The patient with PSA was immediately assessed by a contrast-enhanced computed tomography because of a transient ischemic episode with no evidence of hypercoagulability. Newborns suspected of having arterial thrombosis may need urgent surgical intervention along with thrombolytic and anticoagulant therapy to prevent organ ischemia and amputation of extremities. Conversely, some PSA cases have reportedly been treated conservatively. This vascular anomaly was previously reported as a cause of lower limb ischemia only in a newborn. PSA is a critical differential diagnosis of neonatal arterial thrombosis that needs urgent therapeutic intervention.

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Reperfusion Injury with Compartment Syndrome Following Systemic Thrombolysis for Cardiac Catheterization-Related Arterial Thrombosis in an Infant

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-1700522 ◽

2019 ◽

Vol 09 (01) ◽

pp. 074-076

Author(s):

Dyan Zhewei Zhang ◽

Teng Hong Tan ◽

Kenneth Pak Leung Wong ◽

Sreekanthan Sundaraghavan ◽

Jonathan Tze Liang Choo

Keyword(s):

Reperfusion Injury ◽

Compartment Syndrome ◽

Cardiac Catheterization ◽

Lower Limb ◽

Arterial Thrombosis ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

Systemic Thrombolysis

AbstractSystemic thrombolysis is increasingly used for management of arterial thrombosis following cardiac catheterization, and complications apart from bleeding manifestations are not well reported. We report the case of an infant with lower limb ischemia secondary to femoral arterial thrombosis, which developed after cardiac catheterization. Systemic thrombolysis resulted in successful reperfusion of the lower limb. However, the infant subsequently developed compartment syndrome, requiring an emergent fasciotomy. This case highlights the importance of surveillance for the development of reperfusion injury-related compartment syndrome postsystemic thrombolysis for arterial thrombosis.

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Thromboelastometry Early Identifies Thrombotic Complications Related to Covid-19: A Case Report

10.21203/rs.3.rs-68755/v1 ◽

2020 ◽

Author(s):

Raissa Lanna Araújo San Martin ◽

Tomaz Crochemore ◽

Felicio Aragão Savioli ◽

Fernanda Oliveira Coelho ◽

Rogério da Hora Passos

Keyword(s):

Infectious Disease ◽

Pulmonary Embolism ◽

Lower Limb ◽

Early Identification ◽

Arterial Thrombosis ◽

Clinical Presentation ◽

Limb Ischemia ◽

Case Presentation ◽

Lower Limb Ischemia ◽

Thrombotic Complications

Abstract Background: Covid-19 is a contagious infectious disease, which quickly spread worldwide, whose clinical presentation includes from mild symptoms such as flu to pneumonia and severe acute respiratory syndrome. The severe presentation of the disease can affect different organs and systems. Coagulopathy has been associated with a worse clinical outcome, with manifestations such as pulmonary embolism and systemic arterial thrombosis. Thromboelastometry has been used to identify hypercoagulability in early stages of disease. Case presentation: We report the case of a 59-year-old woman with Covid-19 infection complicated by pulmonary embolism and acute arterial thrombosis associated with critical lower limb ischemia requiring amputation. Conclusions: In this case, thromboelastometry allowed the early identification of hypercoagulability pattern. This reported case showed that the early thromboelastometry can be useful to identify hypercoagulable state to guide the anticoagulant therapy and to avoid thrombotic complications.

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Acute lower limb ischemia in an ICU admitted patient diagnosed with covid 19: a case report

10.22541/au.162692738.89350932/v1 ◽

2021 ◽

Author(s):

Armin Sadeghi ◽

mohammadreza moslemi

Keyword(s):

Case Report ◽

Lower Extremity ◽

Lower Limb ◽

Arterial Thrombosis ◽

Limb Ischemia ◽

Thromboembolic Events ◽

Lower Limb Ischemia ◽

Hospitalized Patient

Thromboembolic events have been reported in hospitalized patient since beginning of the covid 19 pandemic. This study reports an ICU admitted patient with lower extremity arterial thrombosis diagnosed with covid 19.

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Case Report: Acute lower limb ischemia in a recovered COVID-19 patient

F1000Research ◽

10.12688/f1000research.26603.1 ◽

2020 ◽

Vol 9 ◽

pp. 1253

Author(s):

Rawand Abdulrahman Essa ◽

Sirwan Khalid Ahmed

Keyword(s):

Lower Limb ◽

Arterial Thrombosis ◽

Healthcare Workers ◽

Distress Syndrome ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

Anticoagulant Drugs ◽

Lower Limb Pain ◽

Life Threatening ◽

Critical Patients

Arterial thrombosis is rarely reported in relation to COVID-19 patients. It occurs mostly in critical patients especially those with acute respiratory distress syndrome and patients in intensive care units. The cause of arterial thrombosis is mostly related to a cytokine storm. However, limited studies are available regarding arterial thrombosis in COVID-19 disease. Here, we present a case of lower limb ischemia in a moderately symptomatic COVID-19 patient in Iraq within three days after recovery from COVID-19. The patient presented with severe right lower limb pain, forefoot, cyanosed toes, and lower limb ischemia was diagnosed by physical examination and ultrasound. The patient was successfully treated by anticoagulant drugs. Our case alerts healthcare workers that they need to be more cautious of life threatening COVID-19 complications in order to begin early and effective preventive measures.

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Cardiac troponin I in patients with acute upper and lower limb ischemia

VASA ◽

10.1024/0301-1526.37.4.327 ◽

2008 ◽

Vol 37 (4) ◽

pp. 327-332 ◽

Cited By ~ 1

Author(s):

Koutouzis ◽

Sfyroeras ◽

Moulakakis ◽

Kontaras ◽

Nikolaou ◽

...

Keyword(s):

Upper Limb ◽

Lower Limb ◽

Cardiac Troponin ◽

Cardiac Involvement ◽

Troponin I ◽

Limb Ischemia ◽

Elevated Troponin ◽

Troponin Elevation ◽

Lower Limb Ischemia ◽

Ischemia Group

Background: The aim of this study was to investigate the presence, etiology and clinical significance of elevated troponin I in patients with acute upper or lower limb ischemia. The high sensitivity and specificity of cardiac troponin for the diagnosis of myocardial cell damage suggested a significant role for troponin in the patients investigated for this condition. The initial enthusiasm for the diagnostic potential of troponin was limited by the discovery that elevated cardiac troponin levels are also observed in conditions other than acute myocardial infarction, even conditions without obvious cardiac involvement. Patients and Methods: 71 consecutive patients participated in this study. 31 (44%) of them were men and mean age was 75.4 ± 10.3 years (range 44–92 years). 60 (85%) patients had acute lower limb ischemia and the remaining (11; 15%) had acute upper limb ischemia. Serial creatine kinase (CK), isoenzyme MB (CK-MB) and troponin I measurements were performed in all patients. Results: 33 (46%) patients had elevated peak troponin I (> 0.2 ng/ml) levels, all from the lower limb ischemia group (33/60 vs. 0/11 from the acute upper limb ischemia group; p = 0.04). Patients with lower limb ischemia had higher peak troponin I values than patients with upper limb ischemia (0.97 ± 2.3 [range 0.01–12.1] ng/ml vs. 0.04 ± 0.04 [0.01–0.14] ng/ml respectively; p = 0.003), higher peak CK values (2504 ± 7409 [range 42–45 940] U/ml vs. 340 ± 775 [range 34–2403] U/ml, p = 0.002, respectively, in the two groups) and peak CK-MB values (59.4 ± 84.5 [range 12–480] U/ml vs. 21.2 ± 9.1 [range 12–39] U/ml, respectively, in the two groups; p = 0.04). Peak cardiac troponin I levels were correlated with peak CK and CK-MB values. Conclusions: Patients with lower limb ischemia often have elevated troponin I without a primary cardiac source; this was not observed in patients presenting with acute upper limb ischemia. It is very important for these critically ill patients to focus on the main problem of acute limb ischemia and to attempt to treat the patient rather than the troponin elevation per se. Cardiac troponin elevation should not prevent physicians from providing immediate treatment for limb ischaemia to these patients, espescially when signs, symptoms and electrocardiographic findings preclude acute cardiac involvement.

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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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