Multiple arterial thromboemboli after COVID-19

We present the case of a man in his fifties who presented with bilateral lower extremity ischaemia three weeks after COVID-19 infection. The patient had known.

On arrival at the emergency department his left lower extremity had reduced sensation but preserved motor function. His right lower extremity had spontaneously improved on arrival. A CT angiogram showed thromboembolism in both popliteal arteries with extension down the tibiofibular trunk. An acute bilateral mechanical thromboembolectomy of the popliteal artery and tibiofibular trunk was performed. Postoperatively he was hypoxic and a CT thorax angiogram showed bilateral pulmonary embolism, a floating aortic thrombus and ground glass opacification changes typical after COVID-19 viral pneumonia. The patient was systemically anticoagulated. Echocardiography revealed an apical thrombus. There were no signs of cardiac arrhythmia. Haematological diagnostic tests were all negative.

It is presumed that a previous COVID-19 infection contributed to the systemic thrombotic events. The patient was discharged after 9 days in good health and able to walk a normal distance.