Article ; Online: Acute Limb Ischemia in Hospitalized COVID-19 Patients.
2021 Volume 74, Page(s) 88–94
Abstract: Background: COVID-19 is a multisystemic disorder. Hematologic and cardiovascular involvement of COVID-19 causes thromboembolic events across multiple organs which mainly manifest as venous thromboembolism, and rarely, peripheral arterial thromboembolic ... ...
| Abstract | Background: COVID-19 is a multisystemic disorder. Hematologic and cardiovascular involvement of COVID-19 causes thromboembolic events across multiple organs which mainly manifest as venous thromboembolism, and rarely, peripheral arterial thromboembolic events. In-situ thrombosis of a healthy, non-atherosclerotic native artery is rare, and COVID-19 has been reported to be a cause of this phenomenon. We aimed to report our institutional experience with COVID-19 patients who developed acute limb ischemia (ALI) during hospitalization or after discharge. Methods: This was a single-center cross-sectional study. Records of all patients ≥18 years of age admitted to a tertiary center with a confirmed diagnosis of COVID-19 infection between September 1 and December 31, 2020 were retrospectively examined. Data regarding patient demographics, co-morbidities and outcomes were collected. Patients were followed-up during index hospitalization and for 30 days postdischarge. Acute limb ischemia was diagnosed by means of duplex ultrasound and computed tomography angiography in the presence of a clinical suspicion. Results: A total of 681 consecutive patients (38.5% women) were hospitalized with a confirmed diagnosis of COVID-19 during the study period. Median age was 63 years (IQR, 52-74). In-hospital mortality occurred in 94 (13.8%) patients. Ninety (13.2%) patients required intensive care unit admission at some point of their hospital stay. Six (0.9%) patients (one woman) with a median age of 62 years experienced ALI (IQR, 59-64.3). All patients were receiving low molecular weight heparin when they developed ALI. The median of duration between COVID-19 diagnosis and ALI symptom onset was 13 days (IQR, 11.3-14). Three patients underwent emergent surgical thrombectomy combined with systemic anticoagulation, and 3 received systemic anticoagulation alone. Two patients with ALI did not survive to hospital discharge. Among survivors, 1 patient underwent bilateral major amputations, and another underwent a minor amputation within 1 month of hospital discharge. Symptoms of ALI completely resolved in 2 patients without sequelae. Conclusions: COVID-19 is a multisystemic disorder with involvement of hematologic and cardiovascular systems. Despite widespread use of thromboprophylaxis, hospitalized patients with COVID-19 are at increased risk of ALI, and subsequent limb loss or even death. |
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| MeSH term(s) | Acute Disease ; Aged ; Amputation, Surgical ; Anticoagulants/therapeutic use ; COVID-19/complications ; COVID-19/diagnosis ; COVID-19/mortality ; COVID-19/therapy ; Cross-Sectional Studies ; Female ; Hospital Mortality ; Hospitalization ; Humans ; Ischemia/diagnostic imaging ; Ischemia/etiology ; Ischemia/mortality ; Ischemia/therapy ; Limb Salvage ; Male ; Middle Aged ; Patient Discharge ; Peripheral Arterial Disease/diagnostic imaging ; Peripheral Arterial Disease/etiology ; Peripheral Arterial Disease/mortality ; Peripheral Arterial Disease/therapy ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Thrombectomy ; Time Factors ; Treatment Outcome |
| Chemical Substances | Anticoagulants |
| Language | English |
| Publishing date | 2021-04-02 |
| Publishing country | Netherlands |
| Document type | Journal Article ; Observational Study |
| ZDB-ID | 1027366-9 |
| ISSN | 1615-5947 ; 0890-5096 |
| ISSN (online) | 1615-5947 |
| ISSN | 0890-5096 |
| DOI | 10.1016/j.avsg.2021.03.003 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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