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. 2021 Jun 16:20:e20210022.
doi: 10.1590/1677-5449.210022.

Acute arterial ischemia in COVID-19

Silvia Maqueda Ara  1 , Marta Ballesteros Pomar  1 , Nuria Sanz Pastor  1 , Cristina Nogal Arias  2 , Marcos Del Barrio Fernández  1
Affiliations

Acute arterial ischemia in COVID-19

Silvia Maqueda Ara et al. J Vasc Bras. .

Abstract
in English, Portuguese

Since the coronavirus pandemic set in in Spain in March 2020, a noteworthy increase in the incidence of acute limb ischemia (ALI) has been observed. It has been recently discovered that SARS-CoV 2 may lead to ALI secondary to arterial thrombosis. Elevation of D-dimer (DD) in patients with coronavirus infection (COVID-19) indicates that a hypercoagulable state causes acute arterial thrombosis. A remarkably high DD elevation has been reported to be a poor prognosis factor in COVID-19. The ways in which SARS-CoV 2 results in arterial thrombosis may be multiple. On the other hand, surgical revascularization for ALI is associated with poor outcomes in COVID-19 patients, probably in relation to hypercoagulability. Here, we describe two ALI cases in patients who required urgent surgical treatment for limb salvage and were positive for the novel coronavirus infection (COVID 19).

Desde que a pandemia pelo novo coronavírus se estabeleceu na Espanha, em março de 2020, um aumento notável da incidência de isquemia aguda de membros foi observado. Recentemente, descobriu-se que o coronavírus 2 causador da síndrome respiratória aguda grave (SARS-CoV-2) pode ocasionar isquemia aguda de membros secundária à trombose arterial. A elevação do D-dímero em pacientes acometidos pela doença do novo coronavírus (COVID-19) indica o estado de hipercoagulabilidade como causa da trombose arterial aguda. Vale destacar que a alta elevação do D-dímero foi relatada como um fator de prognóstico reservado na COVID-19. Há diversas maneiras pelas quais o SARS-CoV-2 pode resultar em trombose arterial. Em pacientes com COVID-19, a revascularização cirúrgica para isquemia aguda de membros está associada a desfechos desfavoráveis, provavelmente relacionados a hipercoagulabilidade. Descrevemos dois casos de isquemia aguda de membros de pacientes que necessitaram de tratamento cirúrgico de urgência para salvamento de membro e que haviam testado positivo para COVID-19.

Keywords: COVID-19; ischemia; thrombosis.

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Conflict of interest statement

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Figures

Figure 1
Figure 1. Preoperative computed tomography angiography (angio CT) with volume rendering 3D reconstruction: thrombotic occlusion of the right common and external iliac arteries with patent right femoral bifurcation. Of note, healthy and patent left Ilio-femoral axis (a). Iliac intraluminal thrombus protruding into aorta (arrow) (b) (patient #1).
Figure 2
Figure 2. Angio CT with volume rendering 3D reconstruction showing infrafilling of a patent right superficial femoral artery (a). Total occlusion of the right popliteal artery (arrow) with absence of tibial vessels (posterior view). In the left lower extremity, all infrapopliteal vessels are patent (b), (patient #1).
Figure 3
Figure 3. Picture showing patient’s foot several hours after revascularization surgery. Digital cyanosis and fixed staining in foot indicate failed revascularization (a, b) (patient #1).
Figure 4
Figure 4. (a) Chest X-ray revealing bilateral peripheral ground-glass lung opacities (typical feature of COVID-19 pneumonia) as well as multifocal air-space disease; (b) Preoperative picture showing patient’s ischemic foot which required immediate revascularization (patient #2).
See this image and copyright information in PMC

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References

    1. World Health Organization Coronavirus disease (COVID-19) situation dashboard. 2020. [cited 2020 may 5]. https://www.who.int/emergencies/diseases/novel-coronavirus-2019.
    1. Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020;18(6):1324–1329. doi: 10.1111/jth.14859. - DOI - PMC - PubMed
    1. Arachchillage DR, Laffan M. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(5):1233–1234. doi: 10.1111/jth.14820. - DOI - PMC - PubMed
    1. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–847. doi: 10.1111/jth.14768. - DOI - PMC - PubMed
    1. Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023–1026. doi: 10.1111/jth.14810. - DOI - PMC - PubMed

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