SARS-CoV-2 gamma variant and chronic arterial insufficiency due to late arterial thrombosis
Jose Maria Pereira de Godoy1, Guilherme Marum2, Henrique Amorim Santos2
1Department of Cardiovascular Surgery, Medicine School, Sao Jose do Rio Preto-FAMERP, Brazil.
Insights
Severe COVID-19 can cause arterial thrombosis, leading to chronic leg arterial insufficiency. This case highlights the importance of monitoring for vascular complications post-discharge.
Area of Science:
- Vascular Medicine
- Infectious Diseases
- Cardiovascular Surgery
Background:
- Hyperinflammation during COVID-19 is linked to hypercoagulability, a key factor in disease mortality.
- Post-thrombotic syndrome can manifest as chronic arterial insufficiency following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Observation:
- A patient developed severe leg pain and arterial insufficiency 32 days after discharge following SARS-CoV-2 infection.
- Clinical evaluation revealed Rutherford class II.A arterial thrombosis affecting multiple arteries in the affected limb.
Findings:
- Arteriography confirmed thrombosis of the anterior, posterior, and fibular arteries, with non-visualization of the plantar arch.
- Emergency embolectomy achieved partial success, restoring flow only to the posterior tibial artery.
- The patient was managed with continued anticoagulation and aspirin therapy.
Implications:
- This case underscores the potential for delayed-onset chronic arterial insufficiency as a sequela of severe COVID-19.
- Vascular surveillance may be crucial for patients experiencing persistent symptoms after SARS-CoV-2 infection.
- Understanding these long-term vascular complications is vital for improving patient outcomes and management strategies.
Abstract:
The current evidence suggests a state of hypercoagulability as one of the sequelae of hyperinflammation. Thus, it is an important pathogenic mechanism that contributes to increase the mortality caused by COVID-19. The aim of the present study is to report chronic arterial insufficiency after post-thrombosis in the same arteries 32 days later, as a sequel after severe acute respiratory syndrome coronavirus 2 P.1. After the 2nd day of discharge, she had a lot of pain in her left and limiting leg and was referred to the vascular service. The patient was evaluated by vascular surgery who underwent a clinical diagnosis of Rutherford II.A arterial thrombosis and underwent arteriography of the limb that revealed thrombosis of the anterior, posterior, and fibular arteries in the middle third and the plantar arch was not contrasted. She underwent emergency embolectomy with selective isolation of the tibial arteries, but with success after the procedure only for the posterior tibial artery. Anticoagulation was maintained and 100 mg aspirin was associated.
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