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. 2022 Mar 11;11(6):1538.
doi: 10.3390/jcm11061538.

Acute Arterial Thrombosis of Lower Extremities in COVID-19 Patients

Robert Glavinic  1 , Ljiljana Marcic  2   3 , Stipe Dumancic  4 , Mirela Pavicic Ivelja  1   3 , Irena Jeličić  1 , Danijela Kalibovic Govorko  4   5 , Ivana Medvedec Mikić  4   5
Affiliations

Acute Arterial Thrombosis of Lower Extremities in COVID-19 Patients

Robert Glavinic et al. J Clin Med. .

Abstract

Clinical signs and symptoms of COVID-19 varied from asymptomatic forms to severe, life-threatening conditions that required treatment in intensive care units. These severe forms of illness are connected with a hypercoagulable state due to excessive inflammation, hypoxia, immobilisation, and altered angiotensin-converting enzyme 2 (ACE-2). In total, 17 COVID-19 positive patients were diagnosed with peripheral arterial thrombosis (AT), 13 of them had COVID-19 pneumonia. Laboratory findings in patients with X-ray confirmed pneumonia showed a four times higher neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP) and three times higher lactate dehydrogenase level (LDH) than patients without confirmed pneumonia. Patients with pneumonia had significantly more bilateral occlusions of the lower extremities and a significantly higher percentage with complete occlusion of the arteries than patients without pneumonia. The rate of limb loss was 35.3%. They were all from the group with COVID-19 pneumonia. Ten out of thirteen patients with pneumonia died due to acute respiratory distress syndrome (ARDS). All patients without pneumonia were discharged from the hospital. The aim of this retrospective study was to report the incidence of arterial thrombosis of lower extremities and their complications in the acute phase of the infection among COVID-19 patients admitted to the hospital for treatment.

Keywords: COVID-19; SARS-CoV-2; amputation; arterial thrombosis; computed tomography angiography; lower extremity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Frequency of arteries affected by arterial thrombosis in patients of the study population. AIC: a.iliaca communis; AII: a.iliaca interna; AIE: a.iliaca externa; AFC: a.femoralis communis; AFP: a.femoralis profunda; AFS: a.femoralis superficialis; AP: a.poplitea; ATA: a.tibialis anterior; AF: a.fibularis; ATP: a.tibialis posterior.
Figure 2
Figure 2
Axial computed tomography angiography shows (A) occlusion of the left common femoral artery (white arrow) and (B) shows occlusion of the left superficial femoral artery (white arrow).
Figure 3
Figure 3
Coronal computed tomography angiography shows occlusion of the left common femoral artery (white arrows), the same patient as in Figure 2.
Figure 4
Figure 4
CTA volume-rendered 3D reconstruction from a 66-year-old male demonstrates long segment right superficial femoral artery occlusion (white arrow).
See this image and copyright information in PMC

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