A Probable Covid-19 Case Presented with Acute Upper Limb İschemia

Erkul, Gulen Sezer Alptekin; Erkul, Sinan; Parlar, Ali İhsan; Çekirdekçi, Ahmet

doi:10.1016/j.avsg.2021.05.003

Cited by 3 publications

(3 citation statements)

References 15 publications

(19 reference statements)

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“…48e50, 53 Two reports described the successful use of thrombolysis or PMT for reocclusion after open surgical thrombo-embolectomy. 52,54 Since the publication of the 2020 ESVS ALI guidelines, one important paper has been published describing good outcomes using PMT in (non-COVID) patients with ALI, confirming the potential role of percutaneous thrombectomy techniques in the management of ALI. 55 Given the limited resources in ICUs and high dependency units during the pandemic, any technique reducing the time spent in critical care constitutes an obvious advantage.…”

Section: Endovascular Treatmentmentioning

confidence: 94%

“…In several papers, in some patients revascularisation was unsuccessful, despite receiving therapeutic dose anticoagulation and undergoing arterial thromboembolectomy. 14,18,54,59 Reported mortality was 25% (six of 24 patients) and major amputation was required in four surviving patients (22%). 11,13,14,18,44,54,59e66 Post-operative medication and follow up Very few data were identified regarding post-operative medication following revascularisation of ALI in patients with COVID-19.…”

Section: Acute Upper Limb Ischaemiamentioning

confidence: 99%

See 1 more Smart Citation

Update of the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia in Light of the COVID-19 Pandemic, Based on a Scoping Review of the Literature

Jongkind¹,

Earnshaw²,

Gonçalves³

et al. 2022

Journal of Vascular Surgery

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Section: Endovascular Treatmentmentioning

confidence: 94%

Section: Acute Upper Limb Ischaemiamentioning

confidence: 99%

Update of the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia in Light of the COVID-19 Pandemic, Based on a Scoping Review of the Literature

Jongkind¹,

Earnshaw²,

Gonçalves³

et al. 2022

Journal of Vascular Surgery

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“…However, ALI can develop in those without typical risk factors for thrombosis. None of four patients in one review had any history of thromboembolism or risk factors that could justify their ischemia [40]. While ALI is a complication of hospitalized patients with severe COVID-19, it can also occur in patients with mild symptoms, even in patient with an absence of significant respiratory symptoms [43].…”

Section: Acute Limb Ischaemiamentioning

confidence: 97%

Unusual Presentation of Thromboembolic Disease in a Hospitalized Patient With a Covid-19 Infection: A Case Report

Dimova

Ilievska

Minova

et al. 2021

JMS

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With no ideal specific therapy confirmed by the science community, and many low income countries barely being able to obtain a sufficient number of vaccines, as well as the long-term mental health impact, the COVID-19 infection makes for a worldwide health and global problem.Case report A COVID-19 positive patient was admitted due to poor condition, malaise and bilateral interstitial pneumonia with borderline oxygen saturation of 94%, hypoxemia with pO2 of 64mmHg, and elevated C reactive protein (CRP) of 70. The patient was put on oxygen support of 3l/min, and started parenteral antibiotic and LMWH in prophylactic doses -a combination that primarily improved the patient's condition. Three days after hospitalization marked shortness of breath with a drop in oxygen saturation of 62% referred. With further increasing of the oxygen flow, and a transfer to ICU, gas pressures showed significant worsening and the patient was put on mechanical support with a CPAP mask.Despite adding pulsed doses of potent corticosteroid, rapid acting insulin for blood glucose control, and administerring convalescent plasma and parenteral nutrition, the CRP levels were increasing and oxygen was decreasing. Hypotensive, tachycardic and with reduced urine output, the patient was intubated and set up on IPPV mechanical support. Vasopressor stimulation didn't improve the diuresis and elevation of degradation products followed, as well as elevation of the troponin and cardiospecific enzymes -non of which was caused by sepsis.Eight days after admission, the left arm presented as pale, cool and cyanotic. Fully deteriorated laboratory findings of multiple organ system failures (MOFS) were undoubtable; with the oxygen levels incompatible of life, and a CT scan with ARDS presentation, a continuous heparin infusion was the only solution. At the beginning, nothing indicated the deleterious outcome; however, with a highly unusual presentation of arterial thrombosis, the upper limb gangrene became too much and the patient died.COVID-19 is primary a respiratory infection, but the virus can affect other organs and systems, with some very rare presentations and deleterious outcomes.

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Editor's Choice – Update of the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia in Light of the COVID-19 Pandemic, Based on a Scoping Review of the Literature

Jongkind

Earnshaw

Gonçalves

et al. 2022

European Journal of Vascular and Endovascular Surgery

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Objectives Perform a scoping review how COVID-19 patients are affected by acute limb ischaemia (ALI). Evaluate the recommendations of the 2020 ESVS ALI Guidelines for these patients. Methods Research questions were defined, followed by a systematic literature search according to the PRISMA guideline. Abstracts and unpublished literature were not included. The definition of ALI accords to ESVS guidelines. Results Most identified papers were case reports or case series; population-based data and data from randomised controlled trials were also identified, 114 unique and relevant papers were retrieved. Data were conflicting concerning whether the incidence of ALI increased, or remained unchanged, during the pandemic. Case reports and series reported ALI in patients who were younger and healthier than usual, and a greater proportion affecting the upper limb. Whether this is coincidental remains uncertain. The proportion of men/women affected seems unchanged. Most reported cases were in hospitalised patients with severe COVID-19. Patients with ALI as their first manifestation of COVID-19 were reported. Patients with ALI have a worse outcome if they have a simultaneous COVID-19 infection. High levels of D-dimer may predict the occurrence of arterial thromboembolic events in patients with COVID-19. Heparin resistance was observed. Anticoagulation should be given to hospitalized COVID-19 patients in prophylactic dosage. Most of the treatment recommendations of the ESVS Guidelines remained relevant, but the following were modified regarding COVID-19 patients with ALI: 1) CTA imaging before revascularisation should include the entire aorta and iliac arteries. 2) There should be a high index of suspicion, early testing for COVID-19 infection and protective measures are advised. 3) Preferential use of local or locoregional anaesthesia during revascularisation. Conclusion Although the epidemiology of ALI has changed during the pandemic, the recommendations of the ESVS ALI Guidelines remain valid. The above mentioned minor modifications should be considered in COVID-19 patients with ALI.

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A Probable Covid-19 Case Presented with Acute Upper Limb İschemia

Cited by 3 publications

References 15 publications

Update of the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia in Light of the COVID-19 Pandemic, Based on a Scoping Review of the Literature

Update of the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia in Light of the COVID-19 Pandemic, Based on a Scoping Review of the Literature

Unusual Presentation of Thromboembolic Disease in a Hospitalized Patient With a Covid-19 Infection: A Case Report

Editor's Choice – Update of the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia in Light of the COVID-19 Pandemic, Based on a Scoping Review of the Literature

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