COVID-19 Related Acute Lower Limb Ischemia Treated Via Percutaneous Thrombectomy and Catheter Direct Thrombolisis

Background: The aim of this report is to describe and discuss a unique case of acute lower limb ischemia presented in a recovered COVID-19 patient treated via percutaneous mechanical thrombectomy and catheter directed thrombolysis. Starting from this singular case a wide literature review regarding COVID-19-related thrombo-embolic complications has been accomplished. Methods: A 47-year-old male was admitted to the emergency unit with acute lower limb ischemia three weeks after testing positive for COVID-19. He had been isolated at home because of minor COVID-19-related symptoms. Angio-CT-imaging showed a segmental occlusion of the common iliac artery coupled with retro-articular popliteal artery and leg vessels thrombosis. The patient was first unsuccessfully submitted to trans-femoral iliac thrombo-embolectomy. Results: Instead of peripheral limb vessel re-thromboembolectomy, a percutaneous mechanical thrombectomy coupled with leg vessel catheter direct thrombolysis was performed. The completion angiography showed the recanalization of the popliteal artery and leg vessels as far as the ankle but with a reduced forefoot vascularization. The fibrinolytic treatment was continued for 8 hours post-operatively. A compartment syndrome complicated the early post-operative course. There was a progressive recovery of ischemic symptoms and at 6-month follow-up, peripheral pulses were palpable with an almost complete normalization of foot and toe perfusion and motility. Conclusion: Acute lower limb ischemia following COVID-19-related arterial thrombo-embolic events represents a severe complication of COVID-19 infection and may result in a high rate of revascularization failure. In these cases, Percutaneous Mechanical thrombectomy coupled with catheter directed thrombolysis might represent a less traumatic and more selective approach.

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Limb Salvage After Percutaneous Mechanical Thrombectomy in Patients with Acute Lower Limb Ischemia: A Retrospective Analysis from Two Institutions

Annals of Vascular Surgery ◽

10.1016/j.avsg.2018.11.025 ◽

2019 ◽

Vol 58 ◽

pp. 151-159 ◽

Cited By ~ 1

Author(s):

Siyuan Liang ◽

Long Zhou ◽

Kaichuang Ye ◽

Xinwu Lu

Keyword(s):

Retrospective Analysis ◽

Limb Salvage ◽

Lower Limb ◽

Mechanical Thrombectomy ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

Percutaneous Mechanical Thrombectomy

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Potential Benefits From Heating the High-Dose rtPA Boluses Used in Catheter-Directed Thrombolysis for Acute/Subacute Lower Limb Ischemia

Journal of Endovascular Therapy ◽

10.1583/1545-1550(2003)010<0739:pbfhth>2.0.co;2 ◽

2003 ◽

Vol 10 (4) ◽

pp. 739-744 ◽

Cited By ~ 1

Author(s):

Dimitrios K. Tsetis ◽

Asterios N. Katsamouris ◽

Athanasios D. Giannoukas ◽

Adam A. Hatzidakis ◽

Theodoros Kostas ◽

...

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

High Dose ◽

Lower Limb Ischemia ◽

Catheter Directed Thrombolysis ◽

Potential Benefits

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Blunt popliteal artery injury with complete lower limb ischemia: is routine use of temporary intraluminal arterial shunt justified?

Journal of Vascular Surgery ◽

10.1016/j.jvs.2004.03.003 ◽

2004 ◽

Vol 40 (1) ◽

pp. 61-66 ◽

Cited By ~ 59

Author(s):

Ahmed Hossny

Keyword(s):

Popliteal Artery ◽

Lower Limb ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

Artery Injury

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Lower limb ischemia due to popliteal artery compression by Baker cyst

Journal of Vascular Surgery Cases and Innovative Techniques ◽

10.1016/j.jvscit.2017.12.011 ◽

2018 ◽

Vol 4 (2) ◽

pp. 99-101 ◽

Cited By ~ 2

Author(s):

Kazuhiro Fujiyoshi ◽

Yoshiyasu Minami ◽

Taiki Tojo ◽

Dai Iwase ◽

Mitsuhiro Hirata ◽

...

Keyword(s):

Popliteal Artery ◽

Lower Limb ◽

Limb Ischemia ◽

Lower Limb Ischemia

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Successful Catheter-Directed Thrombolysis for Acute Lower Limb Ischemia Secondary to COVID-19 Infection

Annals of Vascular Surgery ◽

10.1016/j.avsg.2020.09.044 ◽

2020 ◽

Author(s):

Kamel Muhammad ◽

Tamer Ghatwary Tantawy ◽

Ragai R. Makar ◽

Oladeji Olojugba

Keyword(s):

Lower Limb ◽

Limb Ischemia ◽

Lower Limb Ischemia ◽

Catheter Directed Thrombolysis

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A Very Rare Cause of Lower Limb Ischemia in Young People: Popliteal Artery Entrapment

The Open Cardiovascular Medicine Journal ◽

10.2174/1874192401812010018 ◽

2018 ◽

Vol 12 (1) ◽

pp. 18-28 ◽

Cited By ~ 4

Author(s):

Hasan Baki Altinsoy ◽

Ozkan Alatas ◽

Emjed Khalil ◽

Kenan Abdurrahman Kara ◽

Candan Cudi Okten ◽

...

Keyword(s):

Young People ◽

Early Diagnosis ◽

Popliteal Artery ◽

Lower Limb ◽

Limb Ischemia ◽

Diagnostic Tools ◽

Type I ◽

Conventional Angiography ◽

Lower Limb Ischemia ◽

Popliteal Artery Entrapment

Background: Popliteal artery entrapment syndrome (PAES) is a very rare pathology that can cause lower extremity ischemia in healthy young people. Anomalous anatomic relationships between the popliteal artery (PA) and the surrounding musculo-tendinous structures cause PAES. We present 31 patients with PAES in 35 limbs that were treated surgically in our clinic within a 12-year period. Patients and Methods: From 2001 to 2015, 31 patients (mean age: 32 ± 7.4 years) underwent surgery for PAES. ; 4 patients presented had bilateral PAES. Doppler ultrasonography (US), magnetic resonance angiography (MRA), and conventional angiography were performed as diagnostic procedures. We detected Type I PAES in 4 limbs and Type II PAES in 12 limbs. In the remaining 19 limbs, we diagnosed Type III or Type IV PAES. Simple release of the PA, PA embolectomy and simple release, and the radial artery (RA) patch angioplasty, with or without thromboendarterectomy (TEA), were performed. In 12 limbs, PA continuity was provided by RA interposition. Results: With the exception of 5 patients, no complications were seen after surgery. Haematoma was detected in 2 patients and local infection in 2 patients. One patient required a revision for recurrent PA thromboembolic event 12 h after surgery. At a median follow- up of 23 months (range: 11-29 months), there were no postoperative complications. Conclusions: PAES can result in lower limb ischemia due to chronic vascular trauma in young healthy patients. The use of diagnostic tools such as US, a non-invasive method, and MRA are effective diagnostic tools for early diagnosis. With their combined approach, exact and early diagnosis can be achieved. PA release, alone or with arterial bypass using RA, is a viable treatment option when intervention is necessary to prevent limb loss in the early stages of the disease.

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Thrombolysis of occluded femoropopliteal graft with locally delivered human plasmin

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1406342n ◽

2014 ◽

Vol 142 (5-6) ◽

pp. 342-346

Author(s):

Dragoslav Nenezic ◽

Djordje Radak ◽

Dario Jocic ◽

Predrag Gajin ◽

Slobodan Tanaskovic ◽

...

Keyword(s):

Lower Limb ◽

Open Surgery ◽

Mechanical Thrombectomy ◽

Bypass Graft ◽

Limb Ischemia ◽

Scar Tissue ◽

Native Artery ◽

Catheter Directed Thrombolysis ◽

Risk Patients ◽

Successful Thrombolysis

Introduction. Acute lower limb ischemia results from thrombosis or embolization of diseased native artery or previously implanted bypass graft. When this occurs, several options are available to restore blood flow: catheter-directed thrombolysis, mechanical thrombectomy or open surgery. Fundamental reasons to apply percutaneous interventions are avoiding open procedures in high risk patients, and avoiding difficult dissection through scar tissue. Case Outline. A 67-year-old male was admitted at our Institution for critical limb ischemia. After performed angiography the diagnosis of occluded femoropopliteal graft was established. Occlusion was resolved by catheter-directed thrombolysis with plasmin. Culprit lesions were treated by angioplasty. Conclusion. Our patient underwent a successful thrombolysis of occluded femoropopliteal graft with locally-delivered human plasmin.

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