Acute limb ischemia in COVID-19 patients: an overview

Hashem Bark Abood; Wael Hamed Alsaedi; Abdulwahab Mohammad Bokhari; Ahmad Mohammed Almughalleq; Ranin Owaidh Algethami; Sama Mohammed Zaini; Hanin Abdulrahman Ayoub; Maan Khaled Baamer; Wael Hassan Alanazi; Ahmed Ebraheem Al Mohammedali; Zoha Saleh Alghamdi

doi:10.18203/2394-6040.ijcmph20211910

Authors

Hashem Bark Abood Deprtment of General Surgery, Consultant of General Surgery, King Fahad Hospital-Al-Baha, KSA
Wael Hamed Alsaedi College of Medicine, Umm Al Qura University-Makkah, KSA
Abdulwahab Mohammad Bokhari Department of Emergency Medicine, King Faisal Hospital-Makkah, KSA
Ahmad Mohammed Almughalleq College of Medicine, Medical University of Lodz-Poland, Poland
Ranin Owaidh Algethami Department of General Surgery, Hera General Hospital-Makkah, KSA
Sama Mohammed Zaini Department of General Surgery, King Fahad General Hospital-Jeddah, KSA
Hanin Abdulrahman Ayoub Department of Pathology, King Faisal Specialist Hospital and Research Center-Jeddah, KSA
Maan Khaled Baamer Department of Emergency Medicine, King Faisal Hospital-Makkah, KSA
Wael Hassan Alanazi College of Medicine, Vision Colleges-Riyadh, KSA
Ahmed Ebraheem Al Mohammedali College of Medicine, Vision Colleges-Riyadh, KSA
Zoha Saleh Alghamdi College of Medicine, King Khalid University-Abha, KSA

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20211910

Keywords:

COVID-19, SARS-CoV-2, Ischemia, ALI, Thrombosis

Abstract

COVID-19 causes a wide range of clinical symptoms. COVID-19 hematologic and cardiovascular involvement induces thromboembolic symptoms in various organs, most notably venous thromboembolism (VTE); peripheral arterial involvement is uncommon. Acute limb ischemia (ALI) is a vascular emergency known as a dramatic drop in arterial perfusion of a limb that poses a challenge to the limb's viability. Given routine need for thromboprophylaxis, hospitalised COVID-19 patients are at an elevated risk of ALI, limb loss, or even mortality. Understanding the various specific symptoms of COVID-19 patients, especially extrapulmonary manifests, is crucial for both better patient care and the development of adequate infection prevention methods. Although ALI is a complication of COVID-19 in hospitalized patients, it is now being understood that it can arise in patients with mild COVID-19 symptoms, and that ALI can be the first presenting sign of COVID-19 even in the absence of respiratory symptoms. It is recommended that acutely admitted COVID-19 cases should be given pharmacologic thromboprophylaxis with low molecular weight heparin (LMWH) or fondaparinux unless there is a chance of bleeding or contraindicated. Anticoagulant treatment, primarily with LMWH, correlates strongly with an improved prognosis in serious COVID-19 patients who follow sepsis-induced coagulopathy requirements or have significantly elevated D-dimer levels.

Metrics

Metrics Loading ...

References

Gomez-Arbelaez D, Ibarra-Sanchez G, Garcia-Gutierrez A, Comanges-Yeboles A, Ansuategui-Vicente M, Gonzalez-Fajardo JA. COVID-19-related aortic thrombosis: a report of four cases. Ann Vasc Surg. 2020;67:10-3.

Hasan SA, Haque A, Nazir F. Acute Limb Ischemia: A Rare Complication of COVID-19. Cureus. 2020;12(11):e11488.

Roberts CM, Levi M, McKee M. COVID-19: a complex multisystem disorder. Br J Anaesth. 2020;125:238-42.

Cheruiyot I, Kipkorir V, Ngure B. Arterial thrombosis in Coronavirus Disease 2019 patients: a rapid systematic review. Ann Vasc Surg. 2021;70:273-81.

Bilaloglu S, Aphinyanaphongs Y, Jones S. Thrombosis in hospitalized patients with COVID-19 in a New York City health system. JAMA. 2020;324:799–801.

Klok F, Kruip M, van der Meer N. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-7.

Shalbub S. The mystery of COVID-19-associated arterial thrombosis. J Vasc Surg. 2020.

Han H., Yang L., Liu R. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020;58(7):1116-20.

Frohman EM, Villemarette-Pittman NR, Melamed E. Part I. SARS-CoV-2 triggered ’PANIC’ attack in severe COVID-19. J Neurol Sci. 2020;116936.

Björck M, Earnshaw JJ, Acosta S, Gonçalves FB, Frederic C, Debus ES, Hinchliffe R, Jongkind V, Koelemay MJW, Menyhei G, Svetlikov AV, Tshomba Y, Van Den Berg JC. Editor’s choice-European society for vascular surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia. Eur J Vasc Endovasc Surg. 2020;59(2):173-218.

Zhou B, She J, Wang Y, Ma X. Venous thrombosis and arteriosclerosis obliterans of lower extremities in a very severe patient with 2019 novel coronavirus disease: a case report. J Thromb Thrombolysis. 2020;50:229-32.

Baccellieri D, Bilman V, Apruzzi L. A case of Covid-19 patient with acute limb ischemia and heparin resistance. Ann Vasc Surg. 2020;68:88-92.

Zhou B, She J, Wang Y, Ma X. Venous thrombosis and arteriosclerosis obliterans of lower extremities in a very severe patient with 2019 novel coronavirus disease: a case report. J Thromb Thrombolysis. 2020;50:229-32.

Owen T. Acute limb ischemia as sole initial manifestation of SARS-CoV-2 infection. J Vascular Surg Cases and Innovative Techn. 2020:511-3.

Al-Zoubi N, Shatnawi N, Jarbo H. Acute Lower Limb Ischemia in Patients Infected with COVID-19. Int J Gen Med. 2021;14:833-39.

Ahmad H, Shubair SM, Kruer J, Hatoum CA. Acute lower-extremity ischemia in a patient with COVID-19. Am J Case Rep. 2020;21:928471.

Bellosta, Raffaello B. Acute limb ischemia in patients with COVID-19 pneumonia. J vascular surg vol. 2020;1020172,6:1864-72.

Canl A. Acute limb ischemia in a COVID-19 patient. Thrombosis Update vol. 2021:2:100031.

Putko, Robert M. SARS-CoV-2 and limb ischemia: A systematic review. J clin orthop trauma. 2020.

Kartikasari, Ulfah. Acute limb ischemia in a patient with Covid-19 pneumonia: a case report. J thrombosis thrombolysis. 2021;1-6.

Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: incidence, pathophysiology, and management. Thromb Res. 2020;194:101-15.

Björck M, Earnshaw JJ, Acosta S, Gonçalves FB, Frederic C, Debus ES et al. Van Den Berg Editor’s choice-European society for vascular surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischemia. Eur J Vasc Endovasc Surg. 2020;29(2):173-218.

Imdes JE, Koleilat I, Hatch AN, Choinski K, Jones DB, Aldailami H et al. Early experience with arterial thromboembolic complications in patients with COVID-19. J Vasc Surg. 2020.

Piazza G, Morrow DA. Diagnosis, management, and pathophysiology of arterial and venous thrombosis in COVID-19. JAMA. 2020;324(24):2548-9.

Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: incidence, pathophysiology, and management. Thromb Res. 2020;194:101-15.

Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997;26(3):517-38.

Fournier M, Faille D, Dossier A. Arterial Thrombotic Events in Adult Inpatients With COVID-19. Mayo Clin Proc. 2021;96:295.

Etkin Y, Conway AM, Silpe J. Acute Arterial Thromboembolism in Patients with COVID-19 in the New York City Area. Ann Vasc Surg. 2021;70:290.

Maurera AH, Vu JH, Rehring TF. Acute Limb Ischemia in Minimally Symptomatic SARS-CoV-2 Infection. J Vasc Interv Radiol. 2020;31:2150.

Kaur P, Posimreddy S, Singh B. COVID-19 Presenting as Acute Limb Ischaemia. Eur J Case Rep Intern Med. 2020;7:001724.

Thompson O, Pierce D, Whang D. Acute limb ischemia as sole initial manifestation of SARS-CoV-2 infection. J Vasc Surg Cases Innov Tech. 2020;6:511.

Singh B, Kaur P, Ajdir N. Covid-19 Presenting as Acute Limb Ischemia. Cureus. 2020;12:e9344.

Wengerter SP, Wengerter KR, Masoudpoor H. Acute aortoiliac and infrainguinal arterial thrombotic events in four patients diagnosed with the novel coronavirus 2019. J Vasc Surg Cases Innov Tech. 2020;6:698.

Katzen BT. Clinical diagnosis and prognosis of acute limb ischemia. Rev Cardiovasc Med. 2002;3(2):S2-6.

Veerasuri S, Kulkarni SR, Wilson WR, Paravastu SCV. Bilateral Acute Lower Limb Ischemia Secondary to COVID-19. Vasc Endovascular Surg 2021;55:196.

Silingardi R, Gennai S, Migliari M. Acute limb ischemia in COVID-19 patients: Could aortic floating thrombus be the source of embolic complications? J Vasc Surg. 2020;72:1152.

Colling ME, Kanthi Y. COVID-19-associated coagulopathy: An exploration of mechanisms. Vasc Med. 2020;25:471.

Paranjpe I, Fuster V, Lala A. Association of treatment dose anticoagulation with in-hospital survival among hospitalized patients with COVID-19. J Am Coll Cardiol. 2020;76:122-4.

Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18:1094-9.

Sánchez JB, Cuipal Alcalde JD, Ramos Isidro R. Acute Limb Ischemia in a Peruvian Cohort Infected by COVID-19. Ann Vasc Surg. 2020;72:196-204.