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Case Reports
. 2023 Mar 13:18:8.
doi: 10.51866/cr.168. eCollection 2023.

COVID-19 related acute limb ischaemia: A case series

Jih Huei Tan  1 , Henry Chor Lip Tan  2 , Addy Aun Wei Ang  3 , Arinah Mahadi Ida  4 , Zi Huan Khoo  5 , Po Hong Tan  6 , Yuzaidi Mohamad  7 , Alwi Imran Rizal  7 , Nur Azmah Tuan Mat Tuan  7
Affiliations
Case Reports

COVID-19 related acute limb ischaemia: A case series

Jih Huei Tan et al. Malays Fam Physician. .

Abstract

COVID-19 infection or vaccination is rarely associated with arterial occlusive disease of the extremities. The surgical department of a hospital in Johor, Malaysia, recorded a significant increase in the number of COVID-19-related acute limb ischaemia when the rates of COVID-19 were high both locally and internationally. The clinical presentation and management of acute limb ischaemia associated with COVID-19 infection or vaccination are largely underreported in Johor. Herein, we report a case series of 12 patients managed with strategies ranging from purely anticoagulation to catheter-directed thrombolysis and surgical embolectomy. This case series describes the clinical presentation, risk profiles, treatment approaches and limb outcomes of the patients. The amputation rate was high in view of unfavourable factors, including delayed presentation, high-risk factors and severe COVID-19. Three cases of potential COVID-19 vaccine-related acute limb ischaemia were included. COVID-19-related acute limb ischaemia can be minimised with heightened alert, preemptive optimisation with proper hydration and consideration for early prophylactic anticoagulation in high-risk cases.

Keywords: Arterial occlusive disease; COVID-19; Limb ischaemia; Thrombolysis.

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Conflict of interest statement

The authors declare no conflicts of interest. No funding was received.

Figures

Figure 1
Figure 1. Computed tomography angiography of the lower limb of case number 2 reveals that the left proximal anterior tibial artery is partially occluded (red arrow).
Figure 2
Figure 2. Catheter angiography of the lower limb of case number 2 reveals that the proximal anterior tibial artery is partially occluded (red arrow, A). The catheter is advanced into the proximal anterior tibial artery, and thrombolysis is successfully achieved, showing no more occlusion (red arrow, B).
Figure 3
Figure 3. Left toe tip gangrene demarcated 1 month post-thrombolysis of the anterior tibial artery in case number 2.
See this image and copyright information in PMC

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