Acute Limb Ischemia in a Peruvian Cohort Infected by COVID-19

Abstract

Background: Coronavirus disease 2019 (COVID-19) infection can cause alterations in the coagulation mechanism conditioning thrombotic phenomena such as acute limb ischemia (ALI) as the only manifestation of the infection. The aim of the study was to describe clinical and surgical characteristics of a group of patients infected with severe acute respiratory syndrome coronavirus 2 who presented ALI in the context of the COVID-19 pandemic at Lima, Peru.

Methods: A multicenter, observational, and retrospective study was performed in six general hospitals, from March to July 2020. The variables considered were the pathological history and associated habits, laboratory tests, the severity of COVID-19 infection and ALI, the anatomic location of the lesion, treatment, evolution, and discharge conditions.

Results: Thirty patients with ALI infected with COVID-19 were evaluated. Their mean age was 60 ± 15 years, the condition being more frequent in men (76.6%). The main comorbidities were arterial hypertension (33.3%), obesity (33.3%), and diabetes mellitus 2 (26.6%). There were 23.3% asymptomatic patients, and their only manifestation was ALI. Rutherford IIA and IIB stage included 93.2% of patients. The most frequent location of the thrombosis was the lower limbs (73.3% vs. 26.6%). Thrombectomy was performed in 76.6% of the patients, and amputation (primary and secondary) was performed in 30% of the patients. The mortality rate was 23.3%, all of it because of acute respiratory distress syndrome.

Conclusions: ALI is a vascular pathology associated with embolic and thrombotic processes. COVID-19 infection can cause severe alterations in coagulation mechanisms, leading some patients to present severe acute arterial complications such as thrombosis, as the only associated manifestation. We report a younger cohort than those described in other studies and with a high frequency of amputations despite adequate surgical treatment.

Fig. 1

(A) CT angiography with three-dimensional reconstruction showing an intraluminal thrombus affecting the common, external, and left internal iliac arteries with distal recanalization (Arrows). (B) CT angiography showing a thrombosis at the level of the origin of the left subclavian artery (Arrow). (C) Arteriography with occlusion of the common and superficial right femoral artery. (D–H) Various clinical manifestations of ALI in patients infected by COVID-19.

Fig. 2

Location of the affected arterial vessel in patients infected by COVID-19 and ALI. SA, subclavian artery; AA, axillary artery; BA, braquial artery; RA, radial artery; UA, ulnar artery; IA, iliac artery; CFA, common femoral artery; DFA, deep femoral artery; SFA, superficial femoral artery; PoA, popliteal artery; ATA, anterior tibial artery; PerA, peroneal artery; PTA, posterior popliteal artery; PeA, pedia artery.