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Severe acute limb ischemia in patients with COVID-19: A single-center case series
Chengjun Yao1, Yanzhao Dong2, Xiaodi Zou3
1Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang Province, PR China; Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, PR China.
Insights
Severe COVID-19-associated acute limb ischemia (ALI) presents unique challenges. Early diagnosis using inflammatory markers and surgical intervention like debridement with flap transplantation improves outcomes, reducing amputation and mortality.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Acute limb ischemia (ALI) is a serious complication of COVID-19.
- An increase in ALI cases was noted following the relaxation of COVID-19 restrictions in China.
Objectives:
Acute limb ischemia (ALI) is a severe complication of COVID-19. Following the lifting of COVID-19 restrictions in China in December 2022, increasing cases of ALI were observed.
Aim:
To describe the clinical features of severe COVID-19-associated ALI and evaluate diagnostic and management strategies.
Methods:
A single-center retrospective study was conducted from December 2022 to March 2023. Among 78 COVID-19-infected ALI patients, 7 severe cases (Rutherford grade III) were included. Clinical characteristics, laboratory findings, treatments, and outcomes were analyzed. Given the small sample size and short study period, the present study should be interpreted as a descriptive case series.
Results:
Patients aged <60 years appeared to have a shorter admission time compared with those aged >60 years. Fever was the most common COVID-19 symptom, and lower-limb ulceration was the predominant ischemic manifestation. Laboratory findings showed neutrophilia, lymphopenia, elevated d-dimer, fibrinogen, hs-CRP, and PCT, with decreased albumin levels. Antibiotics were effective in most cases with open wounds. Surgical debridement with pedicled flap transplantation reduced amputation and mortality rates.
Conclusion:
Severe COVID-19-associated ALI has poor prognosis. Altered coagulation, inflammatory, and myocardial markers aid diagnosis. Debridement combined with pedicled flap transplantation offers favorable therapeutic outcomes.
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