Acute Lower Limb Ischemia as Clinical Presentation of COVID-19 Infection

Abstract

Novel 2019 coronavirus (COVID-19) infection usually causes a respiratory disease that may vary in severity from mild symptoms to severe pneumonia with multiple organ failure. Coagulation abnormalities are frequent, and reports suggest that COVID-19 may predispose to venous and arterial thrombotic complications. We report a case of acute lower limb ischemia and resistance to heparin as the onset of COVID-19 disease, preceding the development of respiratory failure. This case highlights that the shift of coagulation profile toward hypercoagulability was associated with the acute ischemic event and influenced the therapy.

Fig. 1

A, anterior CTA reconstruction showing occlusion of the left iliac axis (white dotted arrows), reperfusion of the common and deep femoral arteries and sequent occlusion at the origin of the superficial femoral artery (gray arrows); B, posterior CTA reconstruction showing left popliteal-tibial vessel occlusion (gray arrow) and right tibioperoneal trunk occlusion with reperfusion of the distal posterior tibial artery (gray dotted arrows).

Fig. 2

Final digital subtraction angiography (DSA) showing incomplete tibial vessel recanalization and absence of forefoot vessels (i.e., “desert foot”). PA, popliteal artery; ATA, anterior tibial artery; PLA, peroneal artery; PTA, posterior tibial artery.