A review of acute limb ischemia in COVID-positive patients

Abstract

This literature review discusses the current evidence on acute limb ischemia (ALI) in patients with COVID-19. Throughout the pandemic, these patients have been at increased risk of arterial thrombotic events and subsequent mortality as a result of a hypercoagulable state. The exact mechanism of thrombosis is unknown; however arterial thrombosis may be due to invasion of endothelial cells via angiotensin-converting enzyme 2 (ACE2) receptors, endothelial injury from inflammation, or even free-floating aortic thrombus. Multiple studies have been performed evaluating the medical and surgical management of these patients; the decision to proceed with operative intervention is dependent on the patient’s clinical status as it relates to COVID-19 and morbidity of that disease. The interventions afforded typically include anticoagulation in patients undergoing palliation; alternatively, thrombectomy (endovascular and open) is utilized in other patients. There is a high risk of rethrombosis, despite anticoagulation, given persistent endothelial injury from the virus. Postoperative mortality can be high in these patients.

Management of Acute Limb Ischaemia Due to COVID-19 Induced Arterial Thrombosis: A Multi-Centre Indian Experience

“…This occurs due to an immune cross reaction with the viral components leading to endotheleitis, platelet activation and endothelial dysfunction. 4 ) This pathogenesis has been corroborated by the work on amputated specimens of patients with Rutherford class 3 ischaemia. 5 ) Endothelial injury with presence of inclusion bodies, widespread thrombosis and accompanying microangiopathy was demonstrated in multiple vascular beds of post mortem subjects.…”

Thrombosis in unvaccinated and Gam-COVID-Vac-vaccinated patients with COVID-19

“…Выбор в пользу аутовенозного кондуита был исключен ввиду наличия у пациента клиники стенокардии, требующей запланированное коронарное шунтирование, что соответствует современным протоколам реваскуляризации в условиях наличия мультифокального атеросклероза [5][6][7][8][9][10]. Среди же 91 (12,0%) тромбозов артерий нижних конечностей невакцинированных больных 48 (5,4%) развились в "чистых" артериях (без признаков атеросклероза), что демонстрирует основной фактор, предрасполагающий к данному состоянию -инфекционный эндотелиит, оптимальной схемы лечения которого на сегодняшний день до сих пор не разработано [1,2,11].…”

“…Повторный тромбоз после успешно выполненной тромбэктомии в боль-шинстве случаев развивался в 1 сут. после операции, что могло быть связано с поражением дистального микроциркуляторного русла [1,2,11,12]. Таким образом, периферическое сопротивление приводило к стазу и нивелировало эффект от хирургического восстановления магистрального кровотока.…”

An extremely rare cause of flank pain: Answers

“…The most important difference between CAC and disseminated intravascular coagulation (DIC) is the severe reduction of fibrinogen and platelet count in DIC [ 26 ]. While venous thromboembolism is most common in CAC, arterial ischemic conditions (extremity, cerebral, coronary, and visceral arteries) can also be seen, as in this case [ 27 , 28 ].…”