COVID-19 diagnosis in a patient with critical limb ischemia: complications and clinical outcomes

Abstract

A 67-year-old male diabetic patient with systemic arterial hypertension was admitted to the emergency department with a necrotic ulcer in the left external malleolus and no palpable popliteal or pedal pulses. Arterial Duplex ultrasound identified femoropopliteal occlusion, with popliteal refilling below the knee and a patent peroneal artery. An endovascular procedure was performed, requiring retrograde access to the popliteal artery to re-establish blood flow and deploy a popliteal stent. Technical success was achieved and the patient underwent debridement of the wound. Two days later, about 48 hours after the operation, the patient began to exhibit respiratory symptoms, with coughing and dyspnea. He immediately underwent a chest CT that identified ground glass opacities, the crazy-paving pattern, and bilateral air bronchogram in the lungs. A reverse transcription – polymerase chain reaction (RT-PCR) test was positive for SARS-Cov-2. The patient was moved to an intensive care unit and put on mechanical ventilation. Both hydroxychloroquine and azithromycin were administered. Despite appropriate treatment, the patient died 4 days after he was diagnosed with COVID-19.

The catastrophic impact of COVID-19 infection in patients with chronic limb-threatening ischemia

“…Notwithstanding the COVID-19 pandemic, chronic limb threatening ischemia (CLTI) continues to be a life-threatening condition, requiring appropriate intervention to avoid mortality and major amputations. 5 The impact of Covid-19 infection on patients with CLTI has not yet been thoroughly studied in the literature. There are case reports in literature showing that patients with CLTI are linked to poorer prognosis when infected with SARS-Cov-2, due to medical comorbidities such as advanced age, hypertension, cardiovascular disease and diabetes.…”

“…There are case reports in literature showing that patients with CLTI are linked to poorer prognosis when infected with SARS-Cov-2, due to medical comorbidities such as advanced age, hypertension, cardiovascular disease and diabetes. 5 …”

Chronic limb ischemia manifestation in COVID-19 infection: awareness and treatment in primary care

“…(11) Moreover, critical limb ischemia remains a life-threatening disease that necessitates prompt treatment to prevent mortality and limb loss. (12) Diagnostic modalities and management strategies in the hospital are able to treat the patient thoroughly. (4) However, patients may come to the primary health facilities at the beginning to treat the symptoms.…”