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SARS-CoV-2 and limb ischemia: A systematic review
Robert M Putko1, Michael D Bedrin1, DesRaj M Clark1
1Department of Orthopaedic Surgery, Uniformed Services University - Walter Reed National Military Medical Center Surgery, Bethesda, MD, 20889, USA.
Journal of Clinical Orthopaedics and Trauma
|December 7, 2020
Summary
Severe acute respiratory syndrome-2 (SARS-CoV-2) infection, the cause of coronavirus disease (COVID-19), is linked to limb ischemia. This review highlights risk factors, treatments, and outcomes, suggesting potential benefits of immunotherapy alongside anticoagulation.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- The coronavirus disease (COVID-19) pandemic presents challenges across medical specialties.
- Limb and digit ischemia have been observed in patients with severe acute respiratory syndrome-2 (SARS-CoV-2) infection.
- Understanding COVID-19-associated limb ischemia is crucial for patient management.
Purpose of the Study:
- To systematically review primary studies on COVID-19 limb and digit ischemia.
- To identify risk factors, comorbidities, and case characteristics.
- To evaluate treatment strategies and outcomes for COVID-19-related ischemia.
Main Methods:
- A comprehensive literature search identified 12 primary studies.
- Data from 47 patients with COVID-19 and limb/digit ischemia were pooled.
- Demographics, clinical presentation, treatments, and outcomes were analyzed.
Main Results:
- The average patient age was 67.6 years, with 79.6% being male.
- Medical and surgical treatment led to 74% limb revascularization, but the mortality rate was 45%.
- Observation alone resulted in 100% symptom resolution, though this was in a small subset of patients.
Conclusions:
- COVID-19 may increase the risk of limb or digital ischemia, potentially due to inflammatory-mediated thrombosis and endothelial injury.
- Immunotherapy combined with anticoagulation may be beneficial for prevention and treatment.
- Treatment strategies and patient outcomes for COVID-19-associated limb ischemia are highly variable.
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