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)

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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Results of the Surgical Management of Acute Limb Ischemia in the Nonagenarians

Annals of Vascular Surgery ◽

10.1016/j.avsg.2020.05.073 ◽

2021 ◽

Vol 70 ◽

pp. 378-385

Author(s):

Arnaud Dubouis ◽

Marjorie Vernier-Mosca ◽

Simon Rinckenbach ◽

Lucie Salomon Du Mont

Keyword(s):

Surgical Management ◽

Limb Ischemia ◽

Acute Limb Ischemia

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Embolism to the main limb arteries in patients with atrial fibrillation

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2021-20-4-14-20 ◽

2022 ◽

Vol 20 (4) ◽

pp. 14-20

Author(s):

M. V. Mel’nikov ◽

A. V. Sotnikov ◽

D. S. Kozhevnikov ◽

M. V. Solov’yeva ◽

S. A . Boldueva

Keyword(s):

Atrial Fibrillation ◽

Limb Ischemia ◽

Limb Amputation ◽

Acute Ischemia ◽

Acute Limb Ischemia ◽

Surgical Department ◽

The Past ◽

Group 3 ◽

Group 1

Introduction. Acute limb ischemia due to embolism in patients with atrial fibrillation remains poorly studied. Objective – to study the clinical significance and role of atrial fibrillation (AF) in the development of embolism to the bifurcation of the aorta and the main arteries of the limbs. Materials and methods. Treatment results of 1816 patients with acute ischemia of the extremities due to embolism treated at a specialized vascular surgical department for the past 30 years were analyzed. 1611 (88.7 %) of them had AF. The distribution into studied groups was according to the period time factor. Group 1 (n = 744) consisted of patients admitted in the period from 1991 to 2000; in group 2 (n = 568) – admitted in the period from 2001 to 2010, in group 3 (n = 299) – from 2011 to 2020. Methods included clinical examination, electrocardiography, Doppler-ultrasound, echocardiography. Results. The role of rheumatic heart disease as a cause of AF has decreased over the past decades by almost 10 times (from 19.5 % in group 1 to 2.0 % in group 3). Currently, the main background diseases for the development of AF are arterial hypertension and various forms of coronary artery disease. Embolism in patients with AF may develop in the arteries of all vascular areas of the systemic circulation, but in the practice of a vascular surgeon more often in the main arteries of minor caliber – the brachial (24.5 %) and popliteal (13.0 %). Multiple embolisms to various vascular areas were found in 2.8 % of patients. Urgent surgical revascularization of the limb by open embolectomy was performed in 1481 (91.9 %) patients that allowed 1348 (83.7 %) to be discharged with limb-sparing. Conclusion. In patients with acute limb ischemia of embologenic ethiology, comorbid AF has 88.7 % of them. Urgent embolectomy allows 83.7 % of patients to be discharged without limb amputation. Hospital mortality in the period 1991–2000 was 15.6 %, the last decade has been reduced to 7.4 %.

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COVID-19 Complicated with Arterial Thrombosis Resulting Acute Limb Ischemia: A Case Report from Bangladesh

Bangladesh Journal of Infectious Diseases ◽

10.3329/bjid.v7i00.50163 ◽

2020 ◽

pp. S50-S56

Author(s):

Md Reaz Uddin Chowdhury ◽

Kazi Shanzida Akter ◽

Sahedul Islam Bhuiyan ◽

Bimal Chandra Das ◽

Mohammad Moksedul Moula ◽

...

Keyword(s):

Arterial Thrombosis ◽

Virus Disease ◽

Rare Complication ◽

Arterial Occlusion ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Rare Presentation ◽

Need To Evaluate ◽

Huge Impact ◽

Few Data

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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Endovascular Procedures For Lower Extremity Vascular Disease: Basics of Endovascular Intervention

DeckerMed Surgery ◽

10.2310/surg.2387 ◽

2018 ◽

Author(s):

Lalithapriya Jayakumar ◽

Mark Davies

Keyword(s):

Lower Extremity ◽

Vascular Disease ◽

Endovascular Procedures ◽

Vascular Diseases ◽

Limb Ischemia ◽

Arterial Disease ◽

Surgical Approaches ◽

Acute Ischemia ◽

Acute Limb Ischemia ◽

Access Complications

The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details these techniques and therapies. Key words: access closure, access complications, acute limb ischemia, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, transcollateral access, transpopliteal access

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Endovascular Procedures For Lower Extremity Vascular Disease: Basics of Endovascular Intervention

10.2310/vasc.2387 ◽

2018 ◽

Author(s):

Lalithapriya Jayakumar ◽

Mark Davies

Keyword(s):

Lower Extremity ◽

Vascular Disease ◽

Endovascular Procedures ◽

Vascular Diseases ◽

Limb Ischemia ◽

Arterial Disease ◽

Surgical Approaches ◽

Acute Ischemia ◽

Acute Limb Ischemia ◽

Access Complications

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Racial disparities in surgical management and outcomes of acute limb ischemia in the United States

Surgery Open Science ◽

10.1016/j.sopen.2021.08.003 ◽

2021 ◽

Author(s):

Matthew Gandjian ◽

Sohail Sareh ◽

Alykhan Premji ◽

Ramsey Ugarte ◽

Zachary Tran ◽

...

Keyword(s):

United States ◽

Racial Disparities ◽

Surgical Management ◽

Limb Ischemia ◽

The United States ◽

Acute Limb Ischemia

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Acute Lower Extremity Ischemia Following an Intervention Requiring a Femoral Vein Access

Journal for Vascular Ultrasound ◽

10.1177/1544316719830848 ◽

2019 ◽

Vol 43 (1) ◽

pp. 30-33

Author(s):

Lalitha C. Medepalli ◽

Paul Braum ◽

Alok Gambhir ◽

Vidya Medepalli

Keyword(s):

Lower Extremity ◽

Femoral Vein ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Surgical Interventions ◽

Vein Access ◽

Limb Perfusion ◽

Lower Extremity Ischemia ◽

High Degree ◽

Extremity Ischemia

Acute limb ischemia is defined as a sudden and rapidly progressing decrease in limb perfusion, usually producing new or worsening symptoms or signs, and often threatening limb viability. Acute limb ischemia is most commonly caused by an acute thrombotic occlusion of a preexisting stenotic arterial segment (60% of cases) or by embolus (30%). Prompt diagnosis and urgent medical and percutaneous/surgical interventions are warranted. If not identified and addressed immediately, decreased perfusion and thrombosis can result in a high degree of limb loss–related morbidity. This report focuses on a rare case of an acute lower extremity ischemia following a lower extremity femoral vein access site–related intervention.

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

Critical Care Explorations ◽

10.1097/cce.0000000000000140 ◽

2020 ◽

Vol 2 (6) ◽

pp. e0140

Author(s):

Krishnan Warrior ◽

Paul A. Chung ◽

Nida Ahmed ◽

Michael C. Soult ◽

Kevin P. Simpson

Keyword(s):

Arterial Thrombosis ◽

Limb Ischemia ◽

Acute Limb Ischemia

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Surgical Management of Vascular Complications in Intravenous Drug Abusers: Experience at the National Institute of Cardiovascular Diseases (NICVD), Bangladesh

Cardiovascular Journal ◽

10.3329/cardio.v3i1.6426 ◽

1970 ◽

Vol 3 (1) ◽

pp. 45-49

Author(s):

AHM Bashar ◽

MN Sabah ◽

MF Hossain ◽

QA Azad ◽

QM Alam ◽

...

Keyword(s):

Drug Abuse ◽

Cardiovascular Diseases ◽

Surgical Management ◽

Vascular Complications ◽

Limb Ischemia ◽

Intravenous Drug ◽

Intravenous Drug Abuse ◽

Acute Limb Ischemia ◽

Economic Implications ◽

Chronic Limb Ischemia

Background: Intravenous drug abuse (IVDA) is a global health care problem that has tremendous socio-economic implications. Vascular complications following IVDA are not uncommon and may have serious consequences. At the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, there has been a steady increase in the number of cases with vascular complications of IVDA in the recent years. Objectives: The present study was undertaken to evaluate our surgical strategy for the management of various vascular complications following IVDA. Materials and Methods: Over the last 5 years, a total of 45 patients presented at the NICVD with various complications of IVDA. Thirty seven patients presented at the emergency department with bleeding from ruptured aneurysm or with impending aneurysm rupture. The remaining 8 patients presented at the vascular outpatient with deep venous thrombosis, superficial thrombophlebitis and chronic venous insufficiency. After resuscitation when necessary, excision of aneurysm was done either with simple ligation of the artery (Group A) or with restoration of arterial continuity (Group B). Outcome in the two groups were compared against the following parameters; acute limb ischemia, chronic limb ischemia, wound infection and lymphorrhoea. Results: There was no in-hospital mortality in this series. Both ligation and restoration of arterial continuity following aneurysmectomy were effective in treating the bleeding aneurysm. However, statistically significant differences were seen between the two groups in terms of acute and chronic limb ischemia. Restoration of arterial continuity was more effective in preventing acute and chronic limb ischemia. Conclusions: In Bangladesh, the incidence of IVDA with vascular complications is increasing at an alarming rate. In patients presenting with arterial pseudoaneurysms, surgical management should be aimed at restoration of arterial continuity whenever feasible. Key words: Intravenous drug abuse, Vascular complication, Aneurysm. DOI: 10.3329/cardio.v3i1.6426Cardiovasc. j. 2010; 3(1): 45-49

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Endovascular Procedures For Lower Extremity Vascular Disease: Specifics of Endovascular Treatment

10.2310/vasc.2388 ◽

2018 ◽

Author(s):

Lalithapriya Jayakumar ◽

Mark Davies

Keyword(s):

Lower Extremity ◽

Endovascular Treatment ◽

Vascular Disease ◽

Endovascular Procedures ◽

Limb Ischemia ◽

Arterial Disease ◽

Surgical Approaches ◽

Acute Ischemia ◽

Acute Limb Ischemia ◽

Chronic Ischemia

The application of endovascular procedures to lower-extremity vascular disease is well established for many common vascular diseases and has often supplanted conventional open surgical approaches. Endovascular therapy for arterial disease in the lower extremity encompasses treatment of acute ischemia, chronic ischemia, and aneurysmal disease. The fundamental skill set and techniques employed are common to all these processes. This chapter details the management of chronic ischemia, acute lower-extremity arterial ischemia, pseudoaneurysms and aneurysms, and arteriovenous malformations. Key words: access closure, access complications, acute limb ischemia, aneurysm endovascular treatment, chronic limb ischemia, intravascular ultrasonography, lower-extremity angiogram, lower limb ischemia, percutaneous transluminal angioplasty, transcollateral access, transpopliteal access

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