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Updated: Nov 1, 2025
Methods for Acute and Subacute Murine Hindlimb Ischemia
Published on: June 21, 2016
A review of acute limb ischemia in COVID-positive patients
Nicole Ilonzo1, Dejah Judelson2, Wissam Al-Jundi3
1Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, 1425 Madison Avenue, 4th Floor, New York, NY 10029.
Insights
Patients with COVID-19 face a higher risk of acute limb ischemia (ALI) due to a hypercoagulable state. Management involves anticoagulation or thrombectomy, but rethrombosis and high mortality remain significant concerns.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Cardiology
Background:
- The COVID-19 pandemic has been associated with an increased incidence of arterial thrombotic events.
- Patients with COVID-19 exhibit a hypercoagulable state, elevating risks for vascular complications.
- Acute limb ischemia (ALI) is a recognized, serious complication in COVID-19 patients.
Purpose of the Study:
- To review current evidence on the presentation, mechanisms, and management of acute limb ischemia in COVID-19 patients.
- To synthesize findings regarding the unique challenges and outcomes of ALI in the context of SARS-CoV-2 infection.
- To provide insights into the decision-making process for medical versus surgical interventions.
Main Methods:
- Comprehensive literature review of studies investigating acute limb ischemia in COVID-19 patients.
- Analysis of reported mechanisms contributing to thrombosis in this population.
- Evaluation of medical and surgical treatment strategies and their outcomes.
Main Results:
- COVID-19 patients are at increased risk of arterial thrombosis, potentially due to endothelial invasion via ACE2 receptors, inflammatory endothelial injury, or aortic thrombus.
- Management strategies vary, including anticoagulation for palliation and thrombectomy (endovascular/open) for other cases.
- High rates of rethrombosis persist despite anticoagulation due to ongoing viral-induced endothelial damage.
Conclusions:
- Acute limb ischemia in COVID-19 is a complex condition with multifactorial causes and significant risks.
- Treatment decisions must balance patient clinical status, COVID-19 severity, and procedural morbidity.
- Postoperative mortality remains a critical concern, underscoring the severity of this complication.
Abstract:
This literature review discusses the current evidence on acute limb ischemia (ALI) in patients with COVID-19. Throughout the pandemic, these patients have been at increased risk of arterial thrombotic events and subsequent mortality as a result of a hypercoagulable state. The exact mechanism of thrombosis is unknown; however arterial thrombosis may be due to invasion of endothelial cells via angiotensin-converting enzyme 2 (ACE2) receptors, endothelial injury from inflammation, or even free-floating aortic thrombus. Multiple studies have been performed evaluating the medical and surgical management of these patients; the decision to proceed with operative intervention is dependent on the patient's clinical status as it relates to COVID-19 and morbidity of that disease. The interventions afforded typically include anticoagulation in patients undergoing palliation; alternatively, thrombectomy (endovascular and open) is utilized in other patients. There is a high risk of rethrombosis, despite anticoagulation, given persistent endothelial injury from the virus. Postoperative mortality can be high in these patients.
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