Acute limb ischemia in a COVID-19 patient

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Hematology

Background:

• Coronavirus disease 2019 (COVID-19) is a global pandemic associated with a hypercoagulable state.
• COVID-19 commonly leads to venous thromboembolism, but arterial thrombosis, including acute limb ischemia (ALI), is less frequent.
• Patients with COVID-19 exhibit deranged coagulation parameters, increasing their risk of thromboembolic events.

Observation:

• A 62-year-old male patient diagnosed with COVID-19 developed spontaneous ALI 12 days post-diagnosis.
• The patient was on therapeutic low molecular weight heparin when ALI symptoms emerged.
• Surgical thrombectomy was unsuccessful, but partial improvement was noted with unfractionated heparin and iloprost infusions.

Findings:

• COVID-19 infection is linked to a higher incidence of ALI.
• ALI can occur in COVID-19 patients despite prophylactic anticoagulation.
• Management of ALI in COVID-19 patients is challenging due to the associated hypercoagulable state.

Implications:

• Prolonged postoperative unfractionated heparin may benefit COVID-19 patients with ALI.
• Vigilance for peripheral arterial involvement is crucial in COVID-19 patients.
• This case underscores the complex vascular complications associated with COVID-19.