A Patient-Tailored Approach to Management of Acute Limb Ischemia in Patients with COVID-19: A Case Series

Introduction: Acute limb ischemia is a critical medical condition that can quickly become a life threat. Therapeutic modalities such as catheter-directed thrombolysis (CDT) have demonstrated various levels of efficacy in previous studies. Objective: This study presents the descriptive findings of a series of cases who presented with acute arterial thrombotic limb ischemia and underwent CDT. Methods: This was a cross-sectional single-hospital-based case series, in which all patients who were diagnosed with acute arterial thrombotic limb ischemia, and consequently underwent CDT during the oneyear study period were included. Detailed baseline characteristics and clinical findings of the studied patients on presentation, after intervention and at one-year follow-up are presented. Results: A total of 21 patients with a mean age of 60.7±15.2 years, including 16 males (76.2%) were included. The initial technical and treatment success rates were 20 (95.2%) and 14 (66.7%), respectively. The amputation-free and the overall survival rates after the one-year follow-up were 15 (71.4%) and 17 (81%), respectively. Four patients (19%) developed complications, two (9.5%) of which were significant (pulmonary hemorrhage and intraventricular hemorrhage). Amputation was performed in 6 (28.6%) cases. Conclusion: In this study, the treatment success rate and the technical success rate were satisfactory.

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A clinical case series of COVID-19-associated acute limb ischemia: real-world situation

The Egyptian Heart Journal ◽

10.1186/s43044-021-00187-0 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Steven Philip Surya ◽

Rony Marethianto Santoso

Keyword(s):

Drug Therapy ◽

Essential Feature ◽

Case Series ◽

Limb Ischemia ◽

Oral Drug ◽

Chronic Obstructive ◽

Acute Limb Ischemia ◽

Current Guideline ◽

Obstructive Pulmonary Disease ◽

Chief Complaints

Abstract Background COVID-19 was a trending topic all year long in 2020. Currently, it is not only a problem for a pulmonologist since it could cause complications to many other organs, including the cardiovascular system. Recent acute COVID-19 infection state has been associated with hypercoagulation and causing microthrombi called immunothrombus. Acute limb ischemia is one of the rare complications but organ-threatening. Unfortunately, unlike coronary artery disease, there is no recent guideline for cardiologists to diagnose and manage acute limb ischemia in pandemic situations Case presentation This case series presented two patients with acute limb injury (ALI)-complicating COVID-19, with chief complaints of pain at their lower extremity. The first patient was an 80-year-old woman who was just dismissed from the hospital due to COVID-19. The distal part of her toe was cyanosed, and her motoric and sensory functions were partially reduced. She was treated with oral drug therapy due to unwillingness to be hospitalized. Interestingly, she had recovered by using oral drug therapy. The second case was a 54-years-old female with several comorbidities such as obesity, type 2 diabetes mellitus, hypertension, dyslipidemia, and chronic obstructive pulmonary disease. She had cyanosed foot and weak arterial pulsation. Unfortunately, she passed away due to acute respiratory distress syndrome. Conclusion Several internal and external factors cause ALI treatment to be more challenging in the pandemic COVID-19 situation. The diagnosis and management of ALI in COVID-19 patients may not fully comply with the current guideline and are likely to be affected by local hospital regulations. Clinical follow-up might be an essential feature in treating ALI in COVID-19 patients.

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Acute limb ischemia in COVID-19 patients and its rehabilitation: a case series from a tertiary care hospital in Central India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20214718 ◽

2021 ◽

Vol 9 (12) ◽

pp. 3676

Author(s):

Rohit Harchandani ◽

Manoj Kela ◽

Abhishek Bawa ◽

Ashish Rathod ◽

Sheikh Wajid ◽

...

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Gastrointestinal Symptoms ◽

Case Series ◽

Central India ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Care Hospital ◽

Disease Spectrum ◽

The Family

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and infectious virus. It belongs to the family coronavirus and it is a single strand positive sense virus. There are many theories which relate to the origin and transmission of this virus and hence the virus has been tagged with many names according to various taxonomical guidelines. The conventional clinical spectrum of this infection includes cough, fever, dyspnea, anorexia and gastrointestinal symptoms. It has been seen during the course of this disease that there are also some properties relating this virus to the hypercoagulability in the disease spectrum. The cases involving arterial and venous thromboembolism are not rare. This case series is a collection on three such cases from the red zone (zone separated for COVID-19 infected patients) of a tertiary care hospital in central India which showcase acute limb ischemia in patients infected with SARS-CoV-2.

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Acute Limb Ischemia in Critically ill COVID-19 Patients: a Case Series and Literature Review

Journal of Medical and Surgical Research ◽

10.46327/msrjg.1.000000000000191 ◽

2021 ◽

pp. 917-922

Author(s):

Soumaya Touzani ◽

Fatimazahra Haddari ◽

Abderrahim Elbouazzaoui ◽

Nawfal Houari ◽

Brahim Boukatta ◽

...

Keyword(s):

Respiratory Symptoms ◽

Clinical Presentation ◽

Case Series ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Vein Thrombosis ◽

Life Threatening ◽

The Mean ◽

Deep Vein ◽

Vascular Burden

Background: The vascular burden increased by COVID-19 infection and including acute limb ischemia (ALI) quickly emerged as a major medical challenge with devastating consequences such as limb loss, multiorgan dysfunction and death. We report a case series of COVID-19 infection associated with ALI to raise awareness and knowledge towards this life-threatening association. Methods: COVIDS-19 patients with acute limb ischemia (ALI) managed in a Moroccan 14 beds COVID-19 ICU between March 2020 and January 2021, were reviewed. Data collected included demographics, clinical presentation, treatments and outcomes. Results: Over the 10-month period, our ICU cared for 407 hospitalized patients with confirmed COVID-19. A total of 6 COVID-19 patients with ALI were identified. The mean age was 61 years (52 - 70) and 5 were men. The most common preexisting condition was diabetes (50%). The mean CRP level was 219 mg/L. Five patients had thrombus in multiple locations. No concomitant deep vein thrombosis was identified. Four patients presented with signs of acute No arterial ischemia with or without respiratory symptoms and were subsequently diagnosed with COVID-19. The remaining two patients developed ischemia during hospitalization. Mean SOFA score was 5 (2 -9). Respiratory support, corticosteroids and heparin therapies were used in all patients. Intubation and vasopressors were required in four patients. Revascularization was performed in five patients and reintervention was necessary in three cases. Four patients died in the ICU while two were successfully discharged. Conclusion: ALI in COVID-19 patients is a challenging life-threatening vascular emergency that requires appropriate multidisciplinary management (intensivists, anesthesiologists, vascular surgeons and interventionists, radiologists, haematologists…) and further studies focused on anticoagulation. Keywords: Acute Limb ischemia, Coagulopathy, COVID-19, SARS-CoV-2, Thrombosis

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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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Acute Limb Ischemia Secondary to Native Artery Occlusion: Results of a Contemporary Case Series

World Journal of Surgery ◽

10.1007/s00268-018-4511-3 ◽

2018 ◽

Vol 42 (8) ◽

pp. 2674-2681

Author(s):

Nuria Seguí ◽

Carlos Ruiz-Carmona ◽

Alina Velescu ◽

Eduardo Mateos ◽

Roberto Elosua ◽

...

Keyword(s):

Case Series ◽

Limb Ischemia ◽

Artery Occlusion ◽

Acute Limb Ischemia ◽

Native Artery

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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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