A rare case of aortic thrombosis in a young COVID-19 positive patient is presented in this case report. Arterial thrombosis developed despite the administration of anticoagulants for treating DVT and PE. The patient underwent axillobifemoral bypass surgery. Limited surgical surveillance, administered steroids and critical health status resulted in wound site infection and consequent graft removal. Aortic endarterectomy and autovenous-patch plasty were performed after the patient's condition improved. Etiopathogenesis of arterial events in the setting of COVID-19 is not entirely understood. It has been suggested that SARS-CoV-2 infection strongly affects vascular endothelial glycocalyx (VEGLX), causes systemic inflammation - reactive microvascular endotheliosis (SIRME), and consequently results in arterial thrombosis.

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Background. Blood flow restore in critical limb ischemia according to angiosomes is becoming very popular. This method allows to restore blood flow precisely to the artery supplying the ischemic zone, based on the angiosome concept. However, angiosome revascularization is not a gold standard because of the lack of evidence supporting this approach. The aim of this study was to compare tissue oxygenation changes in ischemic zone during endovascular revascularization procedure either following angiosome concept or performing indirect revascularization. Methods. A prospective observational study was performed. Patients with critical limb ischemia and tissue loss due to chronic total occlusion of below the knee arteries were included. Endovascular revascularization was performed in all cases. Tissue oxygen saturation was observed intraoperatively using near-infrared spectroscopy. Tissue oxygenation changes near the ischemic wound were compared between direct and indirect revascularization groups. Results. This clinical trial included 30 patients with critical limb ischemia (Rutherford 5) and occluded below the knee arteries intended to treat. In 15 patients the procedure was performed according to angiosome, while the other half underwent indirect revascularization. Tissue oxygenation near the wound was monitored during the intervention. Greater oxygen saturation increase was observed in the group with direct revascularization (29% and 23% accordingly), however the difference between groups was not statistically significant (t-test for independent group, p = 0,544). Conclusions. The increase in tissue oxygen saturation differed very slightly in direct and indirect revascularization groups and the difference was statistically insignificant.

Objectives: Current methods evaluating tissue ischemia are based mainly on evaluating blood flow and not tissue perfusion. However, diabetes mainly affects small vessels and blood flow evaluation is insufficient. The aim of the trial was to evaluate the feasibility of NIRS in measuring perfusion changes during chronic total occlusion (CTO) revascularization in below the knee (BTK) arteries. Methods and Material: A prospective observational study was performed. During the endovascular revascularization procedure, tissue oxygenation changes were measured using three NIRS sensors. Postoperative angiographies and 30 days wound healing was evaluated. Results: The study enrolled 30 patients with chronic limb threatening ischemia, occluded below the knee arteries, Rutherford 5. Mean age 74.7 ± 11.2 years, 16 (53%) of the patients had diabetes mellitus, 10 (33%) had end-stage renal disease. A statistically significant NIRS rSO2 increase was observed on sensors near the wound after the revascularization, p = 0.001. Thirty days follow-up visits included 27 patients, because 3 patients had died. Comparing good wound healing group with poor wound healing group intraoperative NIRS rSO2 increase difference was statistically significant, p = 0.017. Conclusions: The study confirmed tissue perfusion increase could be detected using NIRS during revascularization of below the knee arteries. An intraoperative increase of NIRS rSO2 proved to predict wound healing results.Keywords: near-infrared spectroscopy; blood perfusion; wound healing; chronic limb-threatening ischemia; below the knee; chronic total occlusion Type of Research: Single center prospective observational study.Key Findings: Tissue perfusion increase was detected using NIRS during revascularization of below the knee arteries in 30 patients. NIRS was superior in predicting wound healing compared to a blinded angiography evaluation.Take home Message: Tissue perfusion measurement is of increasing importance due to growing incidence of small vessel disease, which are resulted by diabetes and end stage renal disease. However, there is no validated method to evaluate it. NIRS showed promising intraoperative monitoring results in a very restricted cohort.Summary: NIRS is feasible method for detecting tissue perfusion changes during endovascular revascularization of BTK and BTA arteries. This proof of concept does not translate into clinical practice with existing devices in the market.