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Acute Limb Ischemia in Hospitalized COVID-19 Patients
Ahmet Can Topcu1, Gozde Ozturk-Altunyurt2, Dilara Akman2
1Department of Cardiovascular Surgery, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey.
Insights
Despite thromboprophylaxis, hospitalized COVID-19 patients face a high risk of acute limb ischemia (ALI). This serious complication can lead to limb loss or death, highlighting the need for vigilance.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Hematology
Background:
- COVID-19 (Coronavirus Disease 2019) is a multisystemic illness affecting hematologic and cardiovascular systems.
- This involvement can lead to thromboembolic events, including rare instances of in-situ thrombosis in healthy arteries.
- Acute Limb Ischemia (ALI) is a critical manifestation of these vascular complications.
Purpose of the Study:
- To investigate the incidence and outcomes of ALI in hospitalized patients with COVID-19.
- To report the institutional experience with COVID-19-associated ALI during hospitalization and post-discharge.
Main Methods:
- A single-center, retrospective cross-sectional study was conducted.
- Data from 681 adult patients hospitalized with confirmed COVID-19 between September 1 and December 31, 2020, were analyzed.
- Acute Limb Ischemia was diagnosed using duplex ultrasound and CT angiography, with follow-up for 30 days post-discharge.
Main Results:
- Six (0.9%) patients developed ALI, with a median age of 62 years.
- ALI occurred a median of 13 days after COVID-19 diagnosis, even while on low molecular weight heparin.
- Outcomes included two deaths, one bilateral major amputation, one minor amputation, and two complete resolutions.
Conclusions:
- Hospitalized COVID-19 patients are at significant risk for ALI, despite thromboprophylaxis.
- COVID-19-related hematologic and cardiovascular effects contribute to this risk.
- ALI in COVID-19 patients can result in severe morbidity, including limb loss and mortality.
Background:
COVID-19 is a multisystemic disorder. Hematologic and cardiovascular involvement of COVID-19 causes thromboembolic events across multiple organs which mainly manifest as venous thromboembolism, and rarely, peripheral arterial thromboembolic events. In-situ thrombosis of a healthy, non-atherosclerotic native artery is rare, and COVID-19 has been reported to be a cause of this phenomenon. We aimed to report our institutional experience with COVID-19 patients who developed acute limb ischemia (ALI) during hospitalization or after discharge.
Methods:
This was a single-center cross-sectional study. Records of all patients ≥18 years of age admitted to a tertiary center with a confirmed diagnosis of COVID-19 infection between September 1 and December 31, 2020 were retrospectively examined. Data regarding patient demographics, co-morbidities and outcomes were collected. Patients were followed-up during index hospitalization and for 30 days postdischarge. Acute limb ischemia was diagnosed by means of duplex ultrasound and computed tomography angiography in the presence of a clinical suspicion.
Results:
A total of 681 consecutive patients (38.5% women) were hospitalized with a confirmed diagnosis of COVID-19 during the study period. Median age was 63 years (IQR, 52-74). In-hospital mortality occurred in 94 (13.8%) patients. Ninety (13.2%) patients required intensive care unit admission at some point of their hospital stay. Six (0.9%) patients (one woman) with a median age of 62 years experienced ALI (IQR, 59-64.3). All patients were receiving low molecular weight heparin when they developed ALI. The median of duration between COVID-19 diagnosis and ALI symptom onset was 13 days (IQR, 11.3-14). Three patients underwent emergent surgical thrombectomy combined with systemic anticoagulation, and 3 received systemic anticoagulation alone. Two patients with ALI did not survive to hospital discharge. Among survivors, 1 patient underwent bilateral major amputations, and another underwent a minor amputation within 1 month of hospital discharge. Symptoms of ALI completely resolved in 2 patients without sequelae.
Conclusions:
COVID-19 is a multisystemic disorder with involvement of hematologic and cardiovascular systems. Despite widespread use of thromboprophylaxis, hospitalized patients with COVID-19 are at increased risk of ALI, and subsequent limb loss or even death.
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