Surgical thrombectomy versus conservative treatment in cases of acute limb ischemia with COVID-19 pneumonia

COVID-19 infection is a major cause for acute respiratory distress syndrome, multi-organ dysfunction, coagulopathy, and intravascular thrombosis; therefore, it is the main causative factor for acute limb ischemia.Aim. To compare the treatment outcome of two limb ischemic groups post COVID-19 infection in a single center and detect at least which is better for the patients in the period of COVID-19 pandemic.Material and methods. Here, in this study, we collect 26 patients and divided them into two groups, G1 (14) patients treated conservatively and G2 (12) patients treated with surgical thrombectomy. Data were analyzed to look for the outcome of groups after 24 hours and 30 days.Results. The successful rate of conservative treatment was 85,72% in G1, while it was 75% in G2. There were two amputations below the knee joint in each group. Three patients died in both groups.Conclusion. In conclusion, both conservative treatment and surgical thrombectomy have a comparable successful rate in the selected group of COVID-19 patients.

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Retrograde Surgical Cut-down Direct Thrombectomy as a Salvage Procedure for Acute Limb Ischemia With Below the Knee Thrombotic Occlusion: a Case Series

10.21203/rs.3.rs-739661/v1 ◽

2021 ◽

Author(s):

Ying-Sheng Li ◽

Ying-Ching Li

Keyword(s):

Limb Ischemia ◽

Posterior Tibial Artery ◽

Complete Revascularization ◽

Acute Limb Ischemia ◽

Salvage Procedure ◽

Posterior Tibial ◽

Tibial Artery ◽

Dorsalis Pedis Artery ◽

Below The Knee ◽

Surgical Thrombectomy

Abstract Background: Acute limb ischemia is a serious condition even in an era of highly comprehensive medical treatment. Despite the development of conservative and endovascular treatment, complete removal of the thrombus with antegrade thrombectomy via the femoral approach, especially in below-the-knee arteries, is still not possible. In addition, distal embolization of dislodged debris or thrombus during the procedure is another concern as this might cause severe complications, including amputation. Given the above-mentioned issues, retrograde surgical cut-down direct thrombectomy from the dorsalis pedis artery and posterior tibial artery could be an optimal option for complete revascularization in below-the-knee arteries. Case presentation: We present five cases where the limbs were preserved after retrograde surgical thrombectomy. The standard antegrade thrombectomy procedure with a conventional surgical approach from the common femoral artery was performed. All five patients underwent an intraoperative assessment of indications for dorsalis pedis artery and posterior tibial artery retrograde thrombectomy by the surgical cut-down method. After retrograde thrombectomy, direct evaluation of blood flow was the strongest evidence of revascularization. A retrograde angiogram showed revascularization of below-the-knee arteries. All five patients had successful salvage procedures that prevented major limb amputation. Conclusion: Retrograde surgical thrombectomy could be a salvage procedure for incomplete antegrade thrombectomy.

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Influence of diabetes on diagnostic performance of computed tomography angiography of the calf arteries in acute limb ischemia

Acta Radiologica ◽

10.1177/02841851211006918 ◽

2021 ◽

pp. 028418512110069

Author(s):

Talha Butt ◽

Leena Lehti ◽

Jan Apelqvist ◽

Anders Gottsäter ◽

Stefan Acosta

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Diagnostic Performance ◽

Intraclass Correlation ◽

Arterial Occlusion ◽

Limb Ischemia ◽

Arterial Disease ◽

Diabetic Patients ◽

Acute Limb Ischemia ◽

Below The Knee

Background Patients with diabetes mellitus (DM) have a more extensive distal arterial occlusive disease compared to non-diabetic patients. Diagnostic imaging is a necessity to identify the location and extent of the arterial occlusion in acute limb ischemia (ALI). Computed tomography angiography (CTA) is the most commonly used modality and the diagnostic performance with CTA of calf arteries may be questioned. Purpose To evaluate diagnostic performance of CTA of calf arteries in ALI and to compare patients with and without DM. Material and Methods All thrombolytic treatments performed during 2001–2008 in patients with ALI were included. Initial digital subtraction angiography (DSA) and CTA of all patients were classified according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) below-the-knee arteries and compared to CTA. Two raters assessed the CTA images independently. Inter-rater reliability was expressed as intraclass correlation (ICC) with 95% confidence intervals (CI). Results Patients with (n = 23) and without (n = 85) DM had lower ( P = 0.006) glomerular filtration rate. ICC between CTA and DSA was 0.33 (95% CI –0.22 to 0.56) and 0.71 (95% CI 0.38–0.68) in patients with and without DM, respectively. Sensitivity with CTA for TASC D lesions in patients with and without DM was 0.14 (95% CI –0.12 to 0.40) and 0.64 (95% CI 0.48–0.80), respectively. Conclusion The sensitivity of CTA for assessment of infra-popliteal TASC D lesions in patients with ALI was not acceptable in patients with DM in contrast to those without DM. Another imaging option at present times should be considered for patients with DM.

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Should Patients with Severe Obesity Receive Veno-venous Extra Corporeal Membrane Oxygenation Support in Patients with Acute Respiratory Distress Syndrome? A Single-center Experience

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2020.09.216 ◽

2020 ◽

Vol 26 (10) ◽

pp. S74

Author(s):

Ayesha Azmeen ◽

Naga Vaishnavi Gadela ◽

Colleen Drake ◽

Ethan Kurtzman ◽

David Underhill ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Severe Obesity ◽

Extra Corporeal Membrane Oxygenation ◽

Single Center ◽

Membrane Oxygenation ◽

Single Center Experience

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Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: our single-center experience

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2017.13483 ◽

2017 ◽

Vol 25 (1) ◽

pp. 61-67

Author(s):

Ahmet Yüksel

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Single Center ◽

Membrane Oxygenation ◽

Single Center Experience ◽

Venovenous Extracorporeal Membrane Oxygenation

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

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20210625 ◽

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).

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Outcome in Patients with Acute Limb Ischemia Post Hybrid Procedure Compared to Surgical Thrombectomy

Journal of Indonesian Society for Vascular and Endovascular Surgery ◽

10.36864/jinasvs.2020.2.013 ◽

2020 ◽

Vol 1 (2) ◽

pp. 55-60

Author(s):

Nyityasmono Nugroho ◽

Nyityasmono Tri Nugroho ◽

Dedy Pratama

Keyword(s):

Critical Review ◽

Literature Search ◽

Limb Ischemia ◽

Hybrid Procedure ◽

P Value ◽

High Morbidity ◽

Acute Limb Ischemia ◽

Research Database ◽

Best Management ◽

Surgical Thrombectomy

Introduction: Acute limb ischemia (ALI) is characterized by decreased perfusion to extremities in the form of acute ischemia and the presence of acute thrombus which may endanger the viability of the extremities. Therapeutic modalities are various including intraarterial thrombolysis with or without the help of ultrasonography and the use of thrombectomy instruments. However, due to the high morbidity and mortality rate, a new technique called the hybrid procedure is introduced. This procedure is a combination between endovascular management to correct the abnormalities with the help of angiography as well as thrombectomy surgical management, in the same time. Therefore, it is necessary to conduct a literature search related to the case we are reporting, to determine whether hybrid procedure or thrombectomy only is the best management for ALI. This study aims to determine the best management for the case being reported according to literature search and critical reviews collected from medical research database. Method: From the data collected, there was one interesting case, which is a case about acute limb ischemia, and the following operative management. Afterwards, a literature search was conducted to obtain articles related to the case, and critical review was made regarding the selected article. Results: At the end of the literature search, we found two articles which showed better outcome on hybrid procedure compared to surgical thrombectomy. Compared to the group who underwent thrombectomy, there was decreased 30-days mortality in the group who underwent the hybrid procedure (3.3% vs 4.4%, p-value 0.05), decreased incidence of amputations after 30 days (6.49% vs 13.5%, p-value 0.023), increased limb salvage (91.9% vs 82.3%, p-value 0.03, 95% CI), and decreased two-years mortality (18.7% vs 40.5%; p– value <0.001). Conclusion: Critical review on articles obtained from literature search in online database showed that the outcome hybrid procedure was better than surgical thrombectomy only. Keywords: acute limb ischemia; hybrid procedure; thrombectomy; outcome

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Comorbidities as Risk Factors for Mortality in COVID-19 Acute Respiratory Distress Syndrome Adult Patients: A Single-Center Retrospective Study

International Journal Of Scientific Advances ◽

10.51542/ijscia.v2i6.10 ◽

2021 ◽

Vol 2 (6) ◽

Author(s):

Putra Kurnia Nugraha ◽

Edward Kusuma ◽

Soni Sunarso Sulistiawan ◽

Teuku Aswin Husain

Keyword(s):

Risk Factors ◽

Acute Respiratory Distress Syndrome ◽

Chronic Disease ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Hospital Death ◽

P Value ◽

Chronic Hypertension ◽

Single Center

Background: Geriatric, obesity, and chronic disease are classified as risk factors for adverse outcomes of coronavirus disease 2019 (COVID-19). Studies regarding the importance of these comorbidities in COVID-19 with severe complications such as acute respiratory distress syndrome (ARDS) are scarce. This study aims to analyze age, obesity, and chronic disease comorbidities as risk factors for 28-days mortality in COVID-19 patients with ARDS. Methods: A retrospective, single-center study was conducted in Dr. Soetomo General Hospital, Surabaya, Indonesia between July-October 2020. We included all adult inpatients (≥18 years old) of confirmed COVID-19 with ARDS. Demographic, comorbidities, initial PaO2/FiO2 ratio, time of discharge or death were obtained from medical records and compared the ARDS severity between survivors and non-survivors. The univariate and multivariate logistic regression methods were used to identify risk factors associated with in-hospital death. Result: Among 102 patients of COVID-19 with ARDS, the median age is 52 years. Most of them are within 50 – 59 age categories. The median hospital length of stay (LOS) for survivor is 22 (15.7 – 26) days and 9 (4.25 – 14.4) days for non-survivor. The 28-days mortality rate is 48 (47.1%) patients. Age > 65 years old (HR= 2.7, 95% CI 1.39 – 5.44, p value= 0.004), obesity (HR= 2.2, 95% CI 1.16 – 4.51, p value= 0.016), and chronic hypertension (HR= 1.98, 95% CI 1.11 – 3.52, p value= 0.02) are the independent risk factors for 28-days mortality in COVID-19 with ARDS. Conclusion: Geriatric, obesity, and chronic hypertension comorbidities are the risk factors for mortality of COVID-19 with ARDS complications.

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