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Review
. 2021 Jun 9:20:e20210004.
doi: 10.1590/1677-5449.210004.

Limb ischemia in patients with COVID-19

Julio Cesar Peclat de Oliveira  1 , Walter Jr Boim Araujo  2 , Sergio Quilici Belczak  3 , Fabiano Luiz Erzinger  4 , Lucas Maia Peclat de Oliveira  5 , Marcos Arêas Marques  5   6 , Lucas Mansano Sarquis  7 , Bianca Gutfilen  1
Affiliations
Review

Limb ischemia in patients with COVID-19

Julio Cesar Peclat de Oliveira et al. J Vasc Bras. .

Abstract
in English, Portuguese

This narrative review covers the life-threatening thromboembolic events associated with SARS-CoV-2 infection/COVID-19. It addresses the physical changes that cause vascular and arterial damage to limbs, laboratory management of coagulation, and management of anticoagulation. COVID-19's relationship with deep venous thrombosis and arterial thrombosis is also emphasized. The main thromboembolic events described in the literature are illustrated with examples from our experience with COVID-19 patients.

Esta revisão narrativa abrange os eventos tromboembólicos com risco de vida associados a infecção por SARS-CoV-2/COVID-19. Aborda as mudanças físicas que causam danos vasculares e arteriais aos membros, o manejo laboratorial da coagulação e o manejo da anticoagulação. A relação de COVID-19 com trombose venosa profunda e trombose arterial também é enfatizada. Os principais eventos tromboembólicos descritos na literatura são ilustrados a partir de nossa experiência com pacientes COVID-19.

Keywords: COVID-19; SARS-CoV-2; anticoagulants; embolisms and thrombosis; endovascular techniques; vascular diseases.

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Conflict of interest statement

Conflicts of interest: JCPO, WJBA, MAM and FLE are speakers from the pharmaceutical industry.

Figures

Figure 1
Figure 1. Female patient, 62 years old, hospitalized due to COVID-19, developed an ischemic plaque and possible infectious spot in the left heel, and erythrocyanosis of the forefoot. She was given clinical treatment with full IV heparinization and venous prostaglandin for three weeks. Her clinical condition improved, and she was discharged after 30 days.
Figure 2
Figure 2. A young female patient using hormonal contraceptives was admitted to the Emergency with COVID-19 and pain and critical edema in the left lower limb, and absence of distal pulses with no other symptoms (A). Emergency Fogarty thrombectomy was successfully performed on the venous iliac femoral segment (B). Postoperatively, she coursed with worsening laboratory tests and pneumonia. She was discharged after 3 weeks and the limb remains healthy, on oral anticoagulation with rivaroxaban (C).
Figure 3
Figure 3. Male patient, 61 years old, with controlled hypertension, hospitalized due to edema and pain in the left upper limb (A), tested positive for COVID-19. Color Doppler ultrasound revealed extensive arterial thrombosis of the left upper limb, absence of flow in radial and ulnar arteries, and palmar arch. The examination showed evidence of forearm compartment syndrome. The patient underwent decompressive fasciotomy (B) and arterial Fogarty catheter thrombectomy. He progressed well and was discharged on oral anticoagulants.
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