scholarly journals COVID Toes: Concurrent Lower Limb Arterial and Venous Thromboembolism in a Patient with COVID-19 Pneumonitis Presenting with Foot Ischaemia

2021 ◽  
pp. 153857442110456
Author(s):  
Kathryn A. Lee ◽  
Richard S. McBride ◽  
Ranjeet Narlawar ◽  
Rebecca Myers ◽  
George A. Antoniou
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Venous Thromboembolism ◽  
Peripheral Arterial Disease ◽  
Lower Limb ◽  
Respiratory Symptoms ◽  
Arterial Disease ◽  
High Index ◽  
Peripheral Arterial ◽  
High Index Of Suspicion

We present a 74-year-old gentleman, who presented with foot ischaemia requiring bilateral amputation in the absence of radiological signs of occlusive peripheral arterial disease. He was found to have COVID-19 pneumonitis and concurrent arterial and venous thromboemboli despite no initial respiratory symptoms or signs, nor pre-existing risk factors for cardiovascular disease. Patients who present with foot ischaemia with or without respiratory symptoms or signs warrant a high index of suspicion for COVID-19 infection, particularly in those with no predisposing risk factors.

scholarly journals Venous Thromboembolism in Systemic Sclerosis: Prevalence, Risk Factors, and Effect on Survival

2018 ◽  
Vol 45 (7) ◽  
pp. 942-946 ◽  
Author(s):  
Sindhu R. Johnson ◽  
Nabil Hakami ◽  
Zareen Ahmad ◽  
Duminda N. Wijeysundera
Keyword(s):  
Risk Factors ◽  
Systemic Sclerosis ◽  
Venous Thromboembolism ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Anticardiolipin Antibodies ◽  
Vein Thrombosis ◽  
American College Of Rheumatology ◽  
Increased Risk ◽  
Peripheral Arterial

Objective.Whether systemic sclerosis (SSc) confers increased risk of venous thromboembolism (VTE) is uncertain. We evaluated the prevalence, risk factors, and effect of VTE on SSc survival.Methods.A cohort study was conducted of subjects with SSc who fulfilled the American College of Rheumatology/European League Against Rheumatism classification criteria between 1970 and 2017. Deep vein thrombosis was defined as thrombus on extremity ultrasound. Pulmonary embolism was defined as thrombus on thorax computed tomography angiogram. Risk factors for VTE and time to all-cause mortality were evaluated.Results.Of the 1181 subjects, 40 (3.4%) experienced VTE events. The cumulative incidence of VTE was 2.7 (95% CI 1.9–3.7) per 1000 patient-years. Pulmonary arterial hypertension (PAH; OR 3.77, 95% CI 1.83–8.17), peripheral arterial disease (OR 5.31, 95% CI 1.99–12.92), Scl-70 (OR 2.45, 95% CI 1.07–5.30), and anticardiolipin antibodies (OR 5.70, 95% CI 1.16–21.17) were predictors of VTE. There were 440 deaths. There was no difference in survival between those with and without VTE (HR 1.16, 95% CI 0.70–1.91). Interstitial lung disease (HR 1.54, 95% CI 1.27–1.88) and PAH (HR 1.35, 95% CI 1.10–1.65) were predictors of mortality.Conclusion.The risk of VTE in SSc is comparable to the general population. The presence of PAH, peripheral arterial disease, Scl-70, and anticardiolipin antibodies are risk factors for VTE. VTE does not independently predict SSc survival.

scholarly journals Is There a Risk Factor More Responsible for Disaster?

2015 ◽  
Vol 61 (3) ◽  
pp. 245-247
Author(s):  
Carasca Cosmin ◽  
Muresan Vasile Adrian ◽  
Tilea Ioan ◽  
Magdas Annamaria ◽  
Carasca Emilian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Peripheral Arterial Disease ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Risk Level ◽  
Critical Ischemia ◽  
Medium Risk ◽  
Peripheral Arterial

Abstract Background: Risk factors for peripheral arterial disease are generally the same as those responsible for the ischemic heart disease and in both cases are overlapping risk factors involved in the etiology of atherosclerosis, such as smoking, dyslipidemia, diabetes and hypertension. Case report: We present a case of a 61 years old male, whose ischemic peripheral symptoms began in 2003, at the age of 49, presenting as a Leriche syndrome. The patient was subjected to first revascularization procedure consisting in aortic-bifemoral grafting in the same year. General examination revealed no risk factors except smoking. Only a year after, he returns with critical right lower limb ischemia due to bypass thrombosis, therefore two thrombectomies were performed followed by a right side femoro-popliteal bypassing with Dacron prosthesis. The patient’s condition was good until 2008 when a femoro-popliteal bypass using inverted autologus saphenous vein was imposed due to occlusion of the previous graft. In 2013 the patient was readmitted to hospital with left lower limb critical ischemia. A femoro-popliteal bypass was performed, followed by two thrombectomies and the amputation of the left thigh. Up to this date, the patient kept smoking. Discussions: Although our patient has a low/medium risk level of atherosclerosis by Framingham score and a minimum Prevent III score, all the surgical revascularization procedures were not able to avoid the amputation. Conclusions: There are enough reasons to believe that smoking as a single risk factor can strongly influence the unfavorable progression to amputation in patients with peripheral arterial disease.

scholarly journals Transpedal Approach in Failed Antegrade Attempt of Lower Limb Peripheral Arterial Disease—A Review with Different Treatment Strategies

2020 ◽  
Vol 29 (03) ◽  
pp. 143-148
Author(s):  
Ranjit Kumar Nath ◽  
Siva Subramaniyan ◽  
Neeraj Pandit ◽  
Deepankar Vatsa
Keyword(s):  
High Risk ◽  
Peripheral Arterial Disease ◽  
Femoral Artery ◽  
Lower Limb ◽  
Treatment Strategies ◽  
Arterial Disease ◽  
Retrograde Approach ◽  
Femoral Access ◽  
Antegrade Approach ◽  
Peripheral Arterial

AbstractTranspedal access is an evolving technique primarily used in patients after failed femoral antegrade approach to revascularize complex tibiopedal lesions. In patients who are at high risk for surgery the transpedal access may be the only option in failed antegrade femoral access to avoid amputation of the limbs. In recent years transpedal access is used routinely to revascularize supra-popliteal lesions due to more success and less complications over femoral artery approach. Retrograde approach parse will not give success in all cases and importantly success depends on techniques used. There are different techniques that need to be used depending on lesion characteristics, comorbidities, and hardware available to improve success with less complications. This review provides different strategies for successful treatment of iliac and femoral artery lesions by transpedal approach after failed antegrade femoral attempt.

scholarly journals The Role of Circulating Biomarkers in Peripheral Arterial Disease

2021 ◽  
Vol 22 (7) ◽  
pp. 3601
Author(s):  
Goren Saenz-Pipaon ◽  
Esther Martinez-Aguilar ◽  
Josune Orbe ◽  
Arantxa González Miqueo ◽  
Leopoldo Fernandez-Alonso ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Limb ◽  
Prediction Models ◽  
Arterial Disease ◽  
Cardiac Damage ◽  
Thrombotic Occlusion ◽  
Medical Treatments ◽  
Peripheral Arterial ◽  
Inflammatory Molecules

Peripheral arterial disease (PAD) of the lower extremities is a chronic illness predominantly of atherosclerotic aetiology, associated to traditional cardiovascular (CV) risk factors. It is one of the most prevalent CV conditions worldwide in subjects >65 years, estimated to increase greatly with the aging of the population, becoming a severe socioeconomic problem in the future. The narrowing and thrombotic occlusion of the lower limb arteries impairs the walking function as the disease progresses, increasing the risk of CV events (myocardial infarction and stroke), amputation and death. Despite its poor prognosis, PAD patients are scarcely identified until the disease is advanced, highlighting the need for reliable biomarkers for PAD patient stratification, that might also contribute to define more personalized medical treatments. In this review, we will discuss the usefulness of inflammatory molecules, matrix metalloproteinases (MMPs), and cardiac damage markers, as well as novel components of the liquid biopsy, extracellular vesicles (EVs), and non-coding RNAs for lower limb PAD identification, stratification, and outcome assessment. We will also explore the potential of machine learning methods to build prediction models to refine PAD assessment. In this line, the usefulness of multimarker approaches to evaluate this complex multifactorial disease will be also discussed.

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