Figure - available from: Case Reports in Cardiology
This content is subject to copyright. Terms and conditions apply.
CT angiogram of abdominal aorta and bilateral lower limbs showing partially occluded thrombus in bilateral profunda femoris artery, completely occluding thrombus in left popliteal artery and tibioperoneal trunk.
Source publication
Thromboembolism is a common complication of SARS-CoV-2, which generally involves venous thromboembolism, although there have been reported cases of arterial thrombosis affecting cerebral, coronary, and visceral arteries, as well as arteries in the extremities. We discuss a case of a 45-year-old diabetic man with COVID-19 who developed late-onset ac...
Citations
... First, patients with COVID-19, due to RF, are in a prone position for a long time, which can lead to blood stasis in the distal part of limbs (the first component of the Virchow's triad). [26][27][28][29][30] However, the prone position is the least significant factor that could lead to arterial thrombosis. Secondly, having an endothelial cell tropism, SARS-CoV-2 provokes inflammation in these cells with the development of endotheliitis. ...
... Secondly, having an endothelial cell tropism, SARS-CoV-2 provokes inflammation in these cells with the development of endotheliitis. [26][27][28][29][30] Thirdly, with a further increase in coagulopathy provoked by viral agents, this substrate becomes a zone of parietal and then occlusive thrombosis, which causes acute ischemia. [31][32][33][34][35] If it regards patients with MFA, the presence of plaques can accelerate the vessel occlusion. ...
Goal:
Analysis of the results of thrombectomy from the arteries of the lower extremities in patients with COVID-19 against the background of different severity of respiratory failure.
Materials and methods:
This retrospective, cohort, comparative study for the period from 05/01/2022 to 20/07/2022 included 305 patients with acute thrombosis of the arteries of the lower extremities against the background of the course of COVID-19 (SARS-CoV-2 Omicron variant). Depending on the type of oxygen support, 3 groups of patients were formed: group 1 (n = 168) - oxygen insufflation through nasal cannulas; group 2 (n = 92) - non-invasive lung ventilation; and group 3 (n = 45) - artificial lung ventilation.
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), rethrombosis (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 (ventilated) patients.
Conclusion:
In patients infected with COVID-19 and on artificial lung ventilation, a more aggressive course of the disease is noted, expressed in an increase in laboratory parameters (C-reactive protein, ferritin, interleukin-6, and D-dimer) of the degree of pneumonia (CT-4 in overwhelming number) and localization of thrombosis of the arteries of the lower extremities, mainly in the tibial arteries.
Coronavirus disease 2019 (COVID-19) is a viral illness known to elicit a hypercoagulable state leading to a myriad of vascular pathologies. Over the course of the COVID-19 pandemic, widespread insults to the venous system have been well documented, with an increasing number of arterial events being reported. Despite the rising incidence of both pathological manifestations, these events are rare, but when present, serve as significant life threats to the patient in question. We report and discuss a case of a 69-year-old female with no thromboembolic risk factors or systemic signs of illness who presented with signs and symptoms consistent with acute limb ischemia (ALI). The patient was ultimately found to have occlusion of multiple arterial and venous vessels. She tested positive for COVID-19 despite being otherwise asymptomatic from a viral syndrome standpoint. To our knowledge, there are no reports in the medical literature of ALI-in the setting of arterial occlusion and concomitant deep vein thrombosis (DVT)-as the sole clinical manifestation in an asymptomatic patient without thrombotic risk factors who was only incidentally found to be COVID-19-positive. This case underscores the atypical manifestations and deleterious effects associated with COVID-19 and the need to have a high index of suspicion for a multitude of pathologies when facing this viral illness.
