Acute Limb Ischemia Due to Arterial Thrombosis Associated With Coronavirus Disease 2019

Abstract

Objectives: To describe a case of acute limb ischemia caused by arterial thrombosis due to coronavirus disease 2019.

Design: Clinical observation of a patient.

Setting: Academic medical center.

Patient: A 59-year-old female with history of hypertension, hyperlipidemia, and prior smoking.

Intervention: Clinical observation and data extraction from electronic medical records.

Measurements and main results: We report a case of peripheral arterial thrombosis associated with coronavirus disease 2019, resulting in acute limb ischemia of the right lower extremity. This event was heralded by a sudden and significant elevation in d-dimer levels. At the time of surgery, a long, gelatinous clot was retrieved from the right popliteal artery. Perioperatively, she continued to have absent pedal Doppler signals and after multiple embolectomy attempts, required distal arterial cut down with removal of additional thrombi and resultant improvement of distal arterial flow.

Conclusions: This case demonstrates the importance of regularly checking d-dimer levels and vigilant monitoring for arterial thrombotic events, as they can rapidly become catastrophic.

Keywords: acute limb ischemia; arterial thrombosis; coagulopathy; coronavirus disease 2019; d-dimer.

Figure 1.

CT angiogram of bilateral lower extremities. A, Axial CT angiogram showing acute thrombosis of right below-knee popliteal artery. B, Coronal view, 3D reconstruction showing acute thrombosis of right below-knee popliteal artery.

Figure 2.

Intraoperative angiography. A, Intraoperative angiography after initial embolectomy at the below-knee popliteal artery. B and C, Intraoperative angiography after guided tibial embolectomy, before distal arterial cutdown.