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

Abstract

Objective: To determine the outcomes following various surgical and medical treatments of Coronavirus disease 2019 (COVID-19) induced acute limb ischaemia. Methods: A retrospective study of patients presenting with COVID induced arterial ischaemia in three hospitals from Southern India during the months of May 2020 to August 2021 was undertaken. These patients were managed by either thrombectomy, primary bypass, thrombolysis, anticoagulation or primary amputation based on the stage of ischaemia and the severity of COVID. Results: A total of 67 limbs in 59 patients were analysed. The average time to intervention was 15 days. Upper limb involvement was seen in 16 and lower limb in 51 limbs. Of the 67 limbs, 39 (58.2%) were treated by open surgical revascularisation, 5 (7.4%) by catheter directed lysis, 17 (25.3%) were managed conservatively and 6 (8.9%) underwent primary amputation. Successful revascularisation could be carried out in 88.6% of patients. A limb salvage rate of 80.6% was achieved in these patients with a re-intervention rate of 13.6%. Major amputation rate was 14.92% and mortality was 13.56%. Conclusion: Limb ischaemia after COVID can be safely managed by open thrombectomy or bypass. Similar rates of limb salvage as in non-COVID acute limb ischaemia can be obtained.

Outcomes of Surgical Revascularization for Acute Limb Ischemia in COVID-19 Patients Comparing to Noninfected Cohort: A Single-Center Observational Prospective Study

“…Clinical and demographic characteristics of the patients with ALI and COVID-19 in our study were similar to those reported by others [ 11 , 12 , 18 ]. The majority of patients were male in a seventh decade of their life and with multiple comorbidities.…”

“…Upper limb ischemia was diagnosed approximately in one quarter of observations. Other authors [ 11 , 17 ] provide similar results with exception of the study published by Sekar et al , where only 29% of cases were categorized as Rutherford IIB [ 18 ]. It is worth to mention that in our study anatomic location of arterial occlusion, severity and duration of ischemia were similar in infected and non-infected patients as well as mean preoperative ABI value.…”

“…Finally, it is important to note, that at the moment nearly all ALI cases associated with COVID-19 were reported among non-vaccinated patients and our study is not an exception [ 18 , 27 ]. Based on this data and relying on high efficiency of current vaccines in prophylaxis of severe forms of COVID-19, the wide-scale vaccination seems to be an important measure in prevention of cases with dangerous combination of ALI and SARS-CoV-2 infection.…”

“…The pandemic of SARS-CoV-2 profoundly affected the logistics of medical care, mostly during the first waves – until wide implementation of testing and vaccination. Some authors reported significant delay in ALI treatment among infected patients [ 18 ]. Vice versa, in our study patients from group A arrived in emergency vascular service nearly two times faster compared to non-infected cohort.…”