Comparison of inhospital outcomes after open thrombectomy versus conservative therapy in patients with acute lower limb artery thrombosis and COVID-19

Abdullaev, I. A.; Abasova, S. V.; Danilchuk, LB; Shramko, VA; Sokolova, Ekaterina V.; Коротких, А. В.; Zharova, A. S.; Kokaya, R V; Казанцев, А. Н.

doi:10.15829/1728-8800-2022-3305

Cited by 4 publications

(4 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Это, в свою очередь, является устойчивым плацдармом для развития повторной тромботической окклюзии [1,2,[5][6][7]. К тому же аналогичное поражение микроциркуляторного русла в комбинации с эффектом реперфузионного синдрома будет способствовать дистализации процесса [2,5,8,13,14]. И в хронологическом финале хирурги сталкиваются не просто с ретромбозом магистральной артерии, а с тотальным тромбозом всех этажей конечности [2,5,8,13,14].…”

Section: Discussionunclassified

“…К тому же аналогичное поражение микроциркуляторного русла в комбинации с эффектом реперфузионного синдрома будет способствовать дистализации процесса [2,5,8,13,14]. И в хронологическом финале хирурги сталкиваются не просто с ретромбозом магистральной артерии, а с тотальным тромбозом всех этажей конечности [2,5,8,13,14]. Итогом станет необратимая ишемия конечности и ампутация [2,5,8,13,14].…”

Section: Discussionunclassified

“…И в хронологическом финале хирурги сталкиваются не просто с ретромбозом магистральной артерии, а с тотальным тромбозом всех этажей конечности [2,5,8,13,14]. Итогом станет необратимая ишемия конечности и ампутация [2,5,8,13,14]. Возможным выходом из проблемы могла бы быть не тромбэктомия, а тромб интимэктомия.…”

Section: Discussionunclassified

“…Таким образом, встает вопрос о целесообразности агрессивной хирургической тактики в этой когорте. Известны публикации, которые свидетельствуют о том, что консервативная антикоагулянтная/дезагрегантная терапия не только сопоставима с результатами открытых операций, но в ряде случаев даже превосходит их [11][12][13][14][15][16]. Однако тех критериев, которые могли бы служить идентификатором к выбору только медикаментозного лечения, до сих пор не предлагалось.…”

Section: Discussionunclassified

See 3 more Smart Citations

Predictors of rethrombosis and death in patients with COVID-19 after lower limb arterial thrombectomy for acute ischemia

et al. 2023

Self Cite

View full text Add to dashboard Cite

Aim. To identify predictors of rethrombosis and death in patients with coronavirus disease (COVID-19) after thrombectomy for acute lower limb ischemia.Material and methods. For the period from April 2020 to January 2022, 189 pa tients with acute arterial lower limb thrombosis and acute lower limb ischemia were included in this study. In all cases, a positive polymerase chain reaction test for SARS-CoV-2 was obtained. According to chest multislice computed tomography, bilateral multisegmental pneumonia was identified as follows: 76 patients — grade 2 (25-50% of lung tissue involvement); 52 patients — grade 3 (50-75%); 61 patients — grade 4 (>75%). Breathing was carried out as follows: in 88 patients — spontaneous; in 42 — with oxygen administration by nasal cannula; 26 — non-invasive ventilation; 33 had artificial ventilation. All acute arterial thromboses developed within the hospital at 4,5±1,5 days after hospitalization. The time between the onset to diagnosis verification was 27,8±5,0 min. The revascularization strategy was established by a multidisciplinary team meeting. The interval between the development of acute ischemia symptoms and surgery was 45,9±6,3 minutes. Thrombectomy was performed according to the standard technique, under local and/or intravenous anesthesia, using 3F-7F Fogarty catheters.Results. Retrombosis developed in 80,4% of cases 6,4±5,1 hours after surgery. In 59,8% of cases, retrombectomy turned out to be ineffective and the patient underwent limb amputation. In 65,6% of patients, a death was established due to multiple organ dysfunction. Among them, limb amputation was performed in 103 patients. Binary logistic regression identified following predictors of retrombosis/ death: age over 70 years (odds ratio (OR), 30,73; 95% confidence interval (CI), 11,52-33,7), obesity (OR, 15,53; 95% CI, 6,41-78,19), diabetes (OR 14,21; 95% CI, 5,86-49,21), vasopressor support (OR 8,55; 95% CI, 4,94-17,93), mechanical ventilation (OR 7,39; 95% CI, 4,81-16,52).Conclusion. Predictors of retrombosis and death in patients with COVID-19 after lower limb arterial thrombectomy are age over 70 years, obesity, diabetes, vasopressor support, and mechanical ventilation.

show abstract

Section: Discussionunclassified

See 2 more Smart Citations

Predictors of rethrombosis and death in patients with COVID-19 after lower limb arterial thrombectomy for acute ischemia

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

Update in Carotid Disease

Казанцев

Коротких

Unguryan

et al. 2023

Current Problems in Cardiology

View full text Add to dashboard Cite

Results of thrombectomy in lower-extremity ischemia in patients with COVID-19 and respiratory failure of different severity

et al. 2022

Self Cite

View full text Add to dashboard Cite

Aim. To analyze the results of thrombectomy in lower-extremity ischemia in patients with coronavirus disease 2019 (COVID-19) and respiratory failure of different severity.Material and methods. This retrospective, cohort, comparative study for the period from May 1, 2020 to March 1, 2022 included 305 patients with acute lower-extremity ischemia and COVID-19. Depending on the type of oxygen support, three groups of patients were formed: group 1 (n=168) — nasal oxygen insufflation; group 2 (n=92) — non-invasive ventilation (NIV); group 3 (n=45) — artificial ventilation (AV). Thrombectomy was carried out according to the standard technique using Fogarty catheters (3F-6F — depending on the vessel size). After the diagnosis was established before and after the start of surgical treatment, all patients received the following therapy: Unfractionated IV heparin infusion at an initial rate of 1000 U/r, adjusted to maintain the activated partial thromboplastin time at 2-3 times the normal value; 2. Oral acetylsalicylic acid 125 mg; 3. Analgesics.Results. Myocardial infarction and ischemic stroke were not detected in the total sample. The highest number of deaths (group 1: 5,3%, n=9; group 2: 72,8%, n=67; group 3: 100%, n=45; p<0,0001), retrombosis (group 1 : 18,4%, n=31; group 2: 69,5%, n=64; group 3: 91,1%, n=41; p<0,0001) and limb amputations (group 1: 9,5%, n=16; group 2: 56,5%, n=52; group 3: 91,1%, n=41; p<0,0001) was recorded in group 3 patients.Conclusion. In patients receiving mechanical ventilation, COVID-19 have more aggressive course, which is expressed in an increase in laboratory para- meters (C-reactive protein, ferritin, interleukin-6, D-dimer), the severity of pneumonia and location of thrombosis in the tibial arteries. Among patients with COVID-19 receiving mechanical ventilation, the greatest number of rethromboses (91,1%), limb amputations (91,1%), and deaths (100%) are noted, which suggests the expediency of abandoning open thrombectomy in favor of anticoagulant/antiplatelet therapy in this cohort of patients. The development of arterial thrombosis in patients with COVID-19 receiving mechanical ventilation is an indicator of a high risk of death. Open thrombectomy in combination with anticoagulant/antiplatelet therapy is most effective in patients on nasal oxygen insufflation or NIV.

show abstract

Comparison of inhospital outcomes after open thrombectomy versus conservative therapy in patients with acute lower limb artery thrombosis and COVID-19

Cited by 4 publications

References 10 publications

Predictors of rethrombosis and death in patients with COVID-19 after lower limb arterial thrombectomy for acute ischemia

Predictors of rethrombosis and death in patients with COVID-19 after lower limb arterial thrombectomy for acute ischemia

Update in Carotid Disease

Results of thrombectomy in lower-extremity ischemia in patients with COVID-19 and respiratory failure of different severity

Contact Info

Product

Resources

About