Acute limb ischemia among patients with COVID-19 infection

Abstract

Introduction SARS-CoV-2 infection has been associated with thrombotic complications such as deep vein thrombosis or stroke. Recently, numerous cases of acute limb ischemia (ALI) have been reported although pooled data are lacking. Methods We systematically searched PubMed, Embase, Scopus, and the Cochrane Library for studies published online up to January 2021 that reported cases with SARS-CoV-2 infection and ALI. Eligible studies should have reported early outcomes including mortality. Primary endpoints included also pooled amputation, clinical improvement and reoperation rates. Results In total, 34 studies (19 case reports and 15 case series/cohort studies) including a total of 540 patients (199 patients were eligible for analysis) were evaluated. All studies were published in 2020. Mean age of patients was 61.6 years (range 39-84 years; data from 32 studies) and 78.4% of patients were of male gender (data from 32 studies). There was a low incidence of comorbidities: arterial hypertension: 49% (29 studies); diabetes mellitus: 29.6% (29 studies); dyslipidemia: 20.5% (27 studies); chronic obstructive pulmonary disease: 8.5% (26 studies); coronary disease: 8.3% (26 studies); and chronic renal disease: 7.6% (28 studies). Medical treatment was selected as first-line treatment for 41.8% of cases. Pooled mortality rate among 34 studies reached 31.4% (95% CI = 25.4% to 37.7%). Pooled amputation rate among 34 studies reached 23.2% (95% CI = 17.3% to 29.7%). Pooled clinical improvement rate among 28 studies reached 66.6% (95% CI = 55.4% to 76.9%). Pooled reoperation rate among 29 studies reached 10.5% (95% CI = 5.7% to 16.7%). Medical treatment was associated with a higher death risk compared to any intervention (OR = 4.04; 95% CI [1.075 – 15.197]; P = .045) although amputation risk was not different between the two strategies (OR = .977; 95% CI [.070 – 13.600]; P = .986) (data from 31 studies). Conclusions SARS-CoV-2 infection is associated with a high risk for thrombotic complications including ALI. Covid-associated ALI presents in patients with a low incidence of comorbidities, and it is associated with a high mortality and amputation risk. Conservative treatment seems to have a higher mortality risk compared to any intervention although amputation risk is similar.

Upper Limb Ischemia Following COVID-19 Infection: A Case Report

“…Tang et al showed that high D-dimer and fibrin degradation product levels were higher in patients who died of COVID-19 infection (8). Ischemia in a healthy non-atherosclerotic artery is rare, but it has been reported in COVID-19 infection (9)(10)(11)(12). The incidence of acute limb ischemia in COVID-19 patients was reported to be about 0.9% (9), which is higher than that in the general population (13) and hospitalized patients with cancer (14).…”

Acute Limb Ischemia Following a Mild Case of COVID-19

“…A recent meta-analysis of hospitalized COVID-19 patients with arterial thrombosis demonstrated a combined mortality rate of 31.4% and a limb loss rate of 23.2% [ 7 , 8 ]. However, De Roquetaillade et al reported that some cases of arterial thrombosis were not prevented by therapeutic levels of anticoagulation [ 9 ]. While most hospitalized patients are placed on DVT prophylaxis, and patients with evidence of thrombus are typically fully anticoagulated, those being treated outpatient for respiratory symptoms are not placed on prophylaxis [ 10 ].…”

An Observational Study on Patients with Acute Limb Ischemia and SARS-CoV-2 Infection: Early and Late Results in Limb Salvage Rate

“…Galyfos et al [40] conducted a systematic review on 34 articles regarding acute limb ischemia and SARS-CoV-2 infection, involving 540 patients. Mortality rate among these patients was 31.4%, while in our study, the rate was 13.18% at 1-month follow-up; the amputation rate among the 540 patients in the review was 23.2%, compared with 13.18% in this study.…”

“…Mortality rate among these patients was 31.4%, while in our study, the rate was 13.18% at 1-month follow-up; the amputation rate among the 540 patients in the review was 23.2%, compared with 13.18% in this study. In the systematic review by Galyfos et al, the medical treatment was selected in 41.8% of cases, and these had a higher risk of death when compared with any other intervention [40]. With the application of a proper surgical treatment (either open surgery or endovascular) and with a systemic anticoagulant treatment, we think that the patients with acute limb ischemia and SARS-CoV-2 infection who present within the revascularization window can have a good prognosis, despite viral presence as a prothrombotic factor.…”