scholarly journals Acute Limb Ischemia in One Dose Vaccination of COVID-19

2021 ◽  
Vol 2 (2) ◽  
pp. 1-4
Author(s):  
Kemas Dahlan ◽  
Yulianto Kusnadi ◽  
Edo Tondas ◽  
Daffa Faturrahman
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Virus Disease ◽  
Limb Ischemia ◽  
Hypercoagulable State ◽  
Anterior Tibial Artery ◽  
Acute Limb Ischemia ◽  
Full Dose ◽  
Arterial Perfusion ◽  
State Management ◽  
Tibial Artery

Introduction: The extraordinary thrombotic manifestations of Corona virus Disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome CoV-2 (SARS-CoV-2) virus, presenting as venous and arterial thrombosis have been reported in several literatures, but in this report, we presented a special case of acute limb ischemia in a patient that has been vaccinated by COVID-19 vaccine. Acute limb ischemia (ALI) is defined as decreasing in arterial perfusion of a limb with a threat to viability of the limb and mortality. COVID-19 has been declared as a global pandemic by the WHO. Patients with COVID-19 have abnormalities in blood coagulation parameters and are prone to thromboembolic events. This hypercoagulable state caused by COVID-19 mainly manifests as venous thromboembolism while peripheral arterial involvement is less frequent. Case: A 54-year diabetic and smoker male has already got one dose COVID-19 vaccination came to our emergency unit with severe acute respiratory syndrome and pain, pale and paresthesia of his left leg. There was pneumonia pattern according to chest X-ray and a ground glass opacity in chest CT-scan, he was confirmed infected by COVID-19 according to RT-PCR test. From CT-Angiography we found multiple thrombosis in the distal aorta, superficial femoral artery (SFA), anterior tibial artery (ATA), and posterior tibial artery (PTA) of left lower extremity. Initial treatment we started with unfractionated heparin, oxygenation, intravenous fluid and analgesia. We managed the patient in isolation ward special for COVID-19. We did thrombectomy to save the limb, nevertheless in few days after we performed amputation at the level of talonavicular joint to the distal part of left foot caused by gangrene. Conclusion: Vaccination can protect from COVID-19 if we vaccinated with full dose and our immune system able to create antibody. The condition will be different in immunocompromised condition and we get not full dose vaccination. Covid-19 Patient with Diabetes and smoker could have higher risk to develop acute limb ischemia because of hypercoagulable state. Management of a COVID-19 patient with cute limb ischemia is more complicated and challenging. Although we have already vaccinated life style modification like wearing a mask, social distancing and using hand sanitizer can give us more protection from Covid 19. Keywords: acute limb ischemia, COVID-19 vaccination, heparinization, thrombectomy

Abstract 16853: Retrograde Peripheral Limb Perfusion for Formidable Femoral Arterial Access in Veno-Arterial ECMO Treatment

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Laszlo Gobolos ◽  
Maurice Hogan ◽  
Vivek Kakar ◽  
Stefan Sanger ◽  
Nuno Raposo ◽  
...  
Keyword(s):  
Posterior Tibial Artery ◽  
The Body ◽  
Anterior Tibial Artery ◽  
Arterial Perfusion ◽  
Arterial Access ◽  
Tibial Artery ◽  
Limb Perfusion ◽  
Va Ecmo ◽  
Ultrasonographic Guidance ◽  
Peripheral Arterial

Introduction: VA ECMO has emerged to a well-established therapeutic method in severe acute heart failure. In the case of peripheral ECMO placement, especially applying direct arterial cannulation, the limb perfusion is often compromised by an occlusive effect of the cannula positioned in the femoral artery. The classical proximal femoral arterial reperfusion branch provides sufficient blood flow via a small auxiliary cannula, but in patients with severe peripheral arterial vasculopathy or with significant tissue depth resulting from obesity, the placement of a peripheral arterial perfusion loop may pose a technical challenge. Methods: In case of emerging peripheral ischemic symptoms at femoral VA ECMO placement, ultrasound scanning of the lower limb vessels is performed. In an uncomplicated vascular situation, antegrade distal perfusion can be established. If a significant vasculopathy is present in the proximal vessels, or any further hindrances, including extreme obesity, physically not allowing a subtle perfusion cannula placement resulting from the discrepancy between the tissue depth and cannula length, retrograde peripheral perfusion could be established via the dorsal pedal artery utilising the Seldinger method. An ultrasonographic guidance is essential; hence there is sometimes no backflow present on the inserted cannula in a critically ischemic limb. Following sufficient de-airing manoeuvres, the retrograde femoral flow can be safely established; NIRS confirms the successful reperfusion in a short timeframe. If the dorsal pedal artery is not sufficient for cannulation purposes, the postmalleolar posterior tibial artery segment or the anterior tibial artery through the similarly named muscle can be utilised for cannulation purposes. Results: Two patients showed a pre-reperfusion calf saturation of 29% and 38%, which has increased to 61% and 64% after re-establishing the distal flow within minutes, respectively. We have experienced no complications emerging during the application of the above method. Conclusions: In case of peripheral vascular disease or the body habitus does not allow safe installation of an antegrade flow device, our retrograde perfusion option can save the affected limb on VA ECMO therapy.

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

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

Changes in Skin Perfusion Pressure After Hyperbaric Oxygen Therapy Following Revascularization in Patients With Critical Limb Ischemia: A Preliminary Study

2019 ◽  
Vol 19 (1) ◽  
pp. 57-62
Author(s):  
Hideharu Nakamura ◽  
Takaya Makiguchi ◽  
Daisuke Atomura ◽  
Yukie Yamatsu ◽  
Ken Shirabe ◽  
...  
Keyword(s):  
Hyperbaric Oxygen ◽  
Critical Limb Ischemia ◽  
Perfusion Pressure ◽  
Limb Ischemia ◽  
Peripheral Circulation ◽  
Anterior Tibial Artery ◽  
Skin Perfusion ◽  
Ischemic Disease ◽  
Tibial Artery ◽  
Skin Perfusion Pressure

Hyperbaric oxygen (HBO) therapy promotes wound healing in patients with ischemic disease; however, HBO-induced changes in skin peripheral circulation have not been evaluated in clinical practice. Here, we investigated these changes in patients with critical limb ischemia (CLI), with a focus on the angiosome of crural blood vessels with blood flow improved by endovascular therapy (EVT). Six patients with CLI and ulcers who were treated with HBO after EVT (7 limbs; 1 patient had ulcers in the bilateral limbs) and 3 healthy subjects (6 limbs) were enrolled. HBO therapy was performed at 2 atm under 100% oxygen for 90 min per session. Skin perfusion pressure (SPP) was measured in the dorsum and sole of the foot 1 hour before (pre-SPP) and after (post-SPP) HBO therapy. ΔSPP was calculated as post-SPP minus pre-SPP. SPP measurement regions were divided into those that did (direct region) and did not (indirect region) correspond to the vascular angiosome in which angiography findings of the crus were improved after EVT; i.e., when the anterior tibial artery was effectively treated with EVT, the dorsum was the direct region and the sole was the indirect region, and vice versa when the posterior tibial artery was treated. In the direct, indirect, and healthy subject groups, the ΔSPPs were 20.5±8.7 (p=0.002), –6.4±10.9, and –15.1±18.1 (p=0.014), respectively; that of the direct group was significantly greater than that of the other groups. These results suggest that short-term improvement of the peripheral circulation by HBO therapy was significant in patients with successful revascularization.

scholarly journals Acute Limb Ischemia in the Young: A Rare Case of Essential Thrombocytosis

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Johanes Nugroho ◽  
Ruth Gunadi
Keyword(s):  
Rare Case ◽  
Laboratory Data ◽  
Limb Ischemia ◽  
Hypercoagulable State ◽  
Acute Limb Ischemia ◽  
Essential Thrombocytosis ◽  
Jak2 Mutation ◽  
Left Lower Extremity ◽  
Catheter Directed Thrombolysis ◽  
Artery Disease

Acute limb ischemia (ALI) is rarely observed in young populations. The hypercoagulable state is a notable cause of ALI other than artery disease progression and cardiac embolization. A hypercoagulable state occurs in essential thrombocytosis because of the overproduction of hematopoietic cells secondary to the mutation of the JAK2, CALR, or MPL genes. We report a rare case of a 37-year-old woman presenting with Rutherford IIA ALI in the left lower extremity. Laboratory data revealed she had a platelet count reaching up to 1.38 mil/μL, with other blood profiles being normal. A JAK2 mutation examination was later performed and proved positive. After careful management with catheter-directed thrombolysis, surgical thrombectomy, and cytoreductive therapy using hydroxyurea, the symptoms subsided and eventually restored the patient to physical activity in less than one month.

scholarly journals Two effective cases of additional pedal artery angioplasty for severe lower limb ischemia following acute thrombotic artery occlusion with hypercoagulable state diseases

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Keisuke Shoji ◽  
Kan Zen ◽  
Kenji Yanishi ◽  
Noriyuki Wakana ◽  
Naohiko Nakanishi ◽  
...  
Keyword(s):  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Artery Occlusion ◽  
Hypercoagulable State ◽  
Acute Limb Ischemia ◽  
Residual Limb ◽  
Case Presentation ◽  
Run Off ◽  
Life Threatening ◽  
Surgical Thrombectomy

Abstract Background Acute limb ischemia (ALI) and critical limb ischemia (CLI) following ALI are life-threatening diseases. The rare potential causes of ALI include hypercoagulable state diseases, such as antiphospholipid syndrome (APS) and essential thrombocythemia (ET). Hypercoagulability often make revascularization for arterial occlusion, especially associated with infrapopliteal lesions, difficult. This is because the vessels have poor run-off, and elevated peripheral vascular resistance associated with microcirculation failure, due to a high thrombus burden. There is no established treatment for this issue. Case presentation A 45 years-old and a 56 years-old male suffered from thrombotic arterial occlusion as a first manifestation of APS and ET, respectively. Combination therapy with aggressive anti-thrombotic therapy and revascularization, such as endovascular therapy and surgical thrombectomy based on the angiosome concept, was performed. However, the high thrombus burden caused a poor pedal outflow, and significant limb ischemia remained. Additional pedal artery angioplasty was performed to improve residual limb ischemia in each case and provided sufficient blood flow to the foot. Conclusion The pedal artery angioplasty for thrombotic pedal artery occlusion cases, associated with hypercoagulable state diseases, seems to be a treatment option for relieving residual limb ischemia.

Subintimal Angioplasty of Isolated Infragenicular Vessels in Lower Limb Ischemia: Long-term Results

2002 ◽  
Vol 9 (4) ◽  
pp. 411-416 ◽  
Author(s):  
Hemant Ingle ◽  
Ahktar Nasim ◽  
Amman Bolia ◽  
Guy Fishwick ◽  
Ross Naylor ◽  
...  
Keyword(s):  
Lower Limb ◽  
Clinical Success ◽  
Limb Ischemia ◽  
Long Term Results ◽  
Peroneal Artery ◽  
Anterior Tibial Artery ◽  
Technical Failure ◽  
Subintimal Angioplasty ◽  
Lower Limb Ischemia ◽  
Tibial Artery

Purpose: To assess the outcome of subintimal angioplasty in treating isolated infragenicular arterial disease in patients with severe lower limb ischemia. Methods: A retrospective study reviewed 67 consecutive patients (39 men; mean age 76 years, range 41–96) who underwent infragenicular subintimal angioplasty between March 1997 and May 2000 for ischemia in 70 limbs. The median length of occlusion was 6 cm (range 1–10) in the below-knee popliteal arteries, 4 cm (range 1–4) in the tibioperoneal trunk, 21 cm(range 1–35) in the anterior tibial artery, 10 (1–30) in the posterior tibial artery, and 5 (range 1–20) in the peroneal artery. Results: The technical and clinical success rates were 86% and 80%, respectively. In the 10 (14%) patients with a technical failure, 3 underwent successful bypass, 4 had an amputation, 1 had a lumbar sympathectomy, and 2 were treated conservatively. Of the 4 (6%) limbs that did not achieve clinical success, 2 patients required femorodistal bypass and their ulcers improved; in the other 2, ulcerations did not heal completely. The cumulative limb salvage rate and freedom from critical limb ischemia (CLI) quantified by Kaplan-Meier life-table analysis were 94% and 84% at 36 months. Mortality rates were 19% at 1 year, 43% at 2 years, and 51% at 3 years. In a subgroup analysis, the rate of CLI was significantly lower in nondiabetics (4%) and than in diabetics (24%, p=0.02), but neither survival nor amputation rates were significantly different. Conclusions: Subintimal angioplasty is a safe and effective procedure for treating isolated crural vessels in patients with severe lower limb ischemia.

scholarly journals Acute limb ischemia in COVID-19 patients: an overview

2021 ◽  
Author(s):  
Hashem Bark Abood ◽  
Wael Hamed Alsaedi ◽  
Abdulwahab Mohammad Bokhari ◽  
Ahmad Mohammed Almughalleq ◽  
Ranin Owaidh Algethami ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Arterial Perfusion ◽  
Arterial Involvement ◽  
Cardiovascular Involvement ◽  
Wide Range ◽  
Peripheral Arterial ◽  
Prevention Methods ◽  
Specific Symptoms

COVID-19 causes a wide range of clinical symptoms. COVID-19 hematologic and cardiovascular involvement induces thromboembolic symptoms in various organs, most notably venous thromboembolism (VTE); peripheral arterial involvement is uncommon. Acute limb ischemia (ALI) is a vascular emergency known as a dramatic drop in arterial perfusion of a limb that poses a challenge to the limb's viability. Given routine need for thromboprophylaxis, hospitalised COVID-19 patients are at an elevated risk of ALI, limb loss, or even mortality. Understanding the various specific symptoms of COVID-19 patients, especially extrapulmonary manifests, is crucial for both better patient care and the development of adequate infection prevention methods. Although ALI is a complication of COVID-19 in hospitalized patients, it is now being understood that it can arise in patients with mild COVID-19 symptoms, and that ALI can be the first presenting sign of COVID-19 even in the absence of respiratory symptoms. It is recommended that acutely admitted COVID-19 cases should be given pharmacologic thromboprophylaxis with low molecular weight heparin (LMWH) or fondaparinux unless there is a chance of bleeding or contraindicated. Anticoagulant treatment, primarily with LMWH, correlates strongly with an improved prognosis in serious COVID-19 patients who follow sepsis-induced coagulopathy requirements or have significantly elevated D-dimer levels.

scholarly journals Endovascular Treatment of Acute Tibioperoneal Trunk Thrombosis. A Clinical Case Report

2019 ◽  
Vol 9 (2) ◽  
pp. 113-117
Author(s):  
D. S. Chigidinova ◽  
B. A. Rudenko ◽  
A. S. Shanoyan ◽  
V. P. Mazaev ◽  
F. B. Shukurov
Keyword(s):  
Clinical Case ◽  
Endovascular Procedures ◽  
High Efficiency ◽  
Early Recognition ◽  
Limb Ischemia ◽  
Lower Leg ◽  
Limb Amputation ◽  
Acute Limb Ischemia ◽  
Acute Thrombosis ◽  
Arterial Perfusion

Introduction. Acute limb ischemia is a severe disorder caused by a sharp drop in the arterial perfusion of the limb. It carries a threat to the limb’s function and viability. The issue of early recognition of acute limb ischemia in surgery is both important and difficult. The current guidelines recommend that patients with acute limb ischemia when the limb is viable should be urgently examined and treated. Restoring the blood flow in patients with acute limb ischemia is a priority, since a significant reduction in arterial perfusion can lead to limb amputation and life-threatening complications. In acute limb ischemia different treatment methods can be used, both open surgery and endovascular procedures. The treatment strategy depends on the localisation, duration of ischemia, neurological deficit, concomitant diseases and risks associated with treatment and its results. Endovascular procedures on the arteries of the lower leg are most often indicated to save a limb. Endovascular procedures on the arteries of the lower leg are indicated more often in patients with critical limb ischemia. Endovascular procedures when the condition is primary demonstrate good outcomes and high efficiency on the arteries of the lower extremities at all levels of the lesion.Materials and methods. This paper presents a clinical case of a successful endovascular procedure performed for the treatment of acute thrombosis of the arteries of the lower leg. Three stents were implanted, with a good angiographically confirmed outcome.Conclusion. Endovascular balloon angioplasty with stenting of the tibioperoneal trunk can result in good outcomes in patients with acute thrombosis of the arteries of the lower leg.

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

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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