Management of COVID-19-related Arterial Thrombosis Leading to Acute Limb-Threatening Ischemia
2021
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
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; (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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