Acute Arterial Occlusions in Patients with COVID-19: Results and Outcomes

In this paper, we aimed to describe a case series report of four patients that were admitted in the emergency room of our vascular and endovascular surgery department with acute arterial occlusion after a diagnosis of Covid-19 infection. The first patient was a male, 50 years, tobacco user, with arterial systemic hypertension and COVID-19 positive that was admitted with an acute arterial occlusion Rutherford IIb in the left lower limb. He was submitted to an arterial thromboembolectomy with Fogarty catheter and had a satisfactory evolution. CASE 2 was a female, 63 years, with arterial systemic hypertension, diabetes, esquizophrenia, that was admitted with acute limb ischemia (ALI) Rutherford III in the upper left limb. Despite attempts do revascularize the upper limb, the patient evolved with a hand amputation. CASE 3 was a Male patient, 49 years, HIV positive, diabetic with previous debridement in both feet due to diabetic foot infection, tobacco user and Rutherford IIb ALI in the right lower limb..The patient was submitted to an arterial thromboembolectomy with Fogarty catheter, however presented with fasciotomy infection and another post-operative complications that led him to die. Finally, CASE 4 was a female patient, 49 years, diabetic, admitted with COVID-19 infection that presented ALI during hospitalization on the right lower limb. She was submitted to proper thromboembolectomy, with a satisfactory evolution and limb salvage. COVID-19 pandemic crisis is a challenging situation that has increased the number of acute arterial thrombosis and embolism urgencies and emergencies surgeries in the vascular world. The four patients related in this paper bring valuable information regarding the impact of COVID-19 on micro and macrovascular system.

Lower Limb Ischemia in Atrial Fibrillation: Unusual Presentation

Introduction: Thrombosis and embolism are the common causes of acute arterial occlusion. Thrombosis mostly arises from underlying cardiac disease such as a trial fibrillation while arterial occlusion by embolism. Thus, an ischemic limb can result from acute arterial occlusion. Early proper diagnosis and prompt treatment within critical time by emergency physician at the initial clinical interviewing is important in saving the affected leg and the life, thus, avoiding limb amputation and death. This paper reports a case in which the cause of acute ischemia of limb was proved with some diagnostic tests to be a trial fibrillation.

The Relationship between Blood Viscosity and Acute Arterial Occlusion

Background: Blood viscosity is a strong predictor of cardiovascular events. However, the relationship between blood viscosity and acute arterial occlusion (AAO) has not been studied adequately so far.Objectives: The aim of the present study was to assess the relationship between whole blood viscosity (WBV) and AAO.Material and methods: The study included 93 patients who were diagnosed with AAO between January 2017 and September 2019, and 90 age- and sex-matched healthy controls. WBV was assessed using a validated calculation formula derived from hematocrit and total plasma protein levels, both as a low (LSR) and a high (HSR) shear rate.Results: There were no significant differences between the two groups in regards to the baseline characteristics, with the exception of smoking and LDL cholesterol levels. Subjects with AAO presented significantly higher WBV values both at LSR (32.2 ± 5.0 vs. 26.6 ± 5.0, p <0.001) and HSR (6.2 ± 0.3 vs. 5.7 ± 0.3, p <0.001). The ROC analysis revealed a cut-off value of 27.4 for WBV at LSR (sensitivity 66%, specificity 64%, AUC = 0.770, p <0.001) and a cut-off value of 5.29 in case of HSR (sensitivity 69%, specificity 74%, AUC = 0.801, p <0.001) for predicting AAO. Multivariate analysis, both LSR (OR 3.33, 95% CI: 1.20–9.43, p = 0.006) and HSR (p = 0.020, OR: 1.70, 95% CI: 1.020–1.123) were independent predictors of AAO.Conclusions: This study demonstrated that WBV levels at both HSR and LSR are significantly higher in the AAO group than in the control subjects, indicating that an increased WBV may be associated with the development of AAO.

Surgical tactics of treatment in patients, suffering an acute arterial ischemia of the lower extremities on background of atherosclerotic arterial affection

Objective. To improve the diagnosis and to optimize a surgical tactics of treatment in patients, suffering an acute ischemia of the lower extremities, severe stage of the extremity ischemia, depending on the prognostic criteria for surgical treatment revealed.Materials and methods. There were examined 70 patients, suffering an acute arterial occlusion: men - 44 (63%), women - 26 (37%) ageing (65.2 ± 3.5) yrs old. The patients were distributed into three groups: the 1st - 32 (45.7%) patients with the arteries embolism revealed, the second - 5 (7.1%) patients with the lower extremities idiopathic arterial thrombosis, and the third - 33 (47.1%) patients with arterial thrombosis, which have developed on background of their atherosclerotic affection. In all the patients there were conducted a general clinical examination, ultrasonographic duplex scanning of the lower extremities arteries, spiral CT with contrasting. In 54 patients a degree of the skeletal muscles damage and a state of the acid-base balance were studied up. Results. In 88% patients a hemodynamically significant atherosclerotic occlusive-stenotic affection of the lower extremities arteries was revealed. The staged tactics of treatment was elaborated for patients, suffering an acute arterial occlusion and atherosclerotic affection of the lower extremities arteries. So on, after performance of thrombectomy the ultrasonographic duplex scanning of the lower extremities arteries is conducted with further application of various methods of revascularization, endovascular and the open-access shunting reconstructive operations on arteries of the lower extremities. Prognostic criteria, determining tactics of treatment in a patient with the extremity vitality preservation, were elaborated. Conclusion. There was established, that while the ischemia duration increase the possibility of the extremity blood flow restoration reduces. A correct tactics selection in patient is promoted due to determination of a rabdomyolisis markers.

Cardiac and extra-cardiac pathologies in patients with acute arterial occlusion

SUMMARY OBJECTIVE: We aimed to investigate cardiac and extra-cardiac pathologies in patients who were operated for acute arterial occlusion. METHODS: Between March 2010 and March 2018, a total of 120 patients who underwent surgical treatment for acute arterial occlusion were included in this retrospective study. RESULTS: 84 (70%) and 27 (22. 5%) of the patients had cardiac and extra-cardiac pathologies, respectively. In 9 (7. 5%) of the cases, no reason for arterial occlusion could be found. Pure atrial fibrillation was found in 39 (32. 5%) patients. Atrial fibrillation and cardiac valvular pathologies were detected in 45 patients (37. 5%). Among those with a cardiac valvular pathology, 9 patients (7. 5%) had pure mitral stenosis, 21 patients (17. 5%) had moderate to advanced mitral stenosis with tricuspid regurgitation, 9 patients (7. 5%) had 20-30 mitral regurgitation with 30 tricuspid regurgitation, 3 patients (2. 5%) had moderate mitral stenosis, 30-40 tricuspid regurgitation and 20-30 aortic stenosis, and 3 patients (2. 5%) had 30 mitral regurgitation, 10- 20 tricuspid regurgitation, calcific moderate aortic stenosis, and coronary artery disease. Among those 27 patients with an extra-cardiac pathology, 21 patients (22. 5%) had peripheral artery disease, 3 patients (2.5%) had an abdominal aortic aneurysm, and 3 patients (2. 5%) had Behçet's Disease. CONCLUSION: Cardiac and extra-cardiac pathologies should be kept in mind in patients with acute arterial occlusion. Thus, detected pathologies could be treated, and the development of additional peripheral emboli could be prevented.