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(a) Computed tomography arteriogram showing non occlusive thrombus in the lower aorta and iliac artery at multiple sites. (b) Distal embolisation in the tibial vessels in the same patient.
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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. Th...
Context in source publication
Context 1
... most common sites of thrombotic occlusions were iliac (n= 17 limbs, 25.37%) and popliteal artery (n= 23 limbs, 34.33%). Majority (45 limbs, 67.16%) of the patients showed multi segmental involvement ( Figs. 1 and 2). Thirty-seven limbs had class 1 or 2A ischaemia (55.23%), 18 had class 2B (28.86%) and 12 had class 3 ischaemia (17.91%). ...
Citations
... numerous papers focused on revascularization techniques and postoperative medical management, but no data is provided regarding the intraoperative standard of care. an initial heparin bolus of 80-100 iu/Kg is usually administered, 27,28 with no differences compared to non-Covid-19 endovascular procedures. Moreover, no dedicated protocols were proposed for intraoperative anticoagulation monitoring. ...
All endovascular procedures need an effective anticoagulation regimen that avoids thrombo-embolic complications due to the insertion and manipulation of various intravascular devices. Systemic heparinization reduces the risk of thrombosis but there is no conclusive evidence regarding the correct use of anticoagulant medications and accordant monitoring, especially in endovascular peripheral arterial procedures. Anticoagulation must be maintained during the whole vascular procedure, especially during partial or complete blood flow interruption. Reaching and maintaining the correct coagulative status is mandatory to avoid or reduce thromboembolic complications that could limit the procedure's effectiveness or be harmful to the patient. Patients' baseline variables and procedure-related elements can influence the way anticoagulation should be administered and how coagulative status has to be monitored. This review aimed to clarify the critical points of anticoagulation and monitoring management for non-cardiac arterial procedures in order to understand the best way to manage vascular procedures anticoagulation.
... 13 At the moment only 4 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. Diabetes mellitus, hypertension, ischemic heart disease, and chronic renal disease were diagnosed more frequently compared to the data provided by Bellosta et al. 19 We found that COVID-19 positive patients had lower rate of atrial fibrillation and, respectively, of embolic cause of ALI compared to the noninfected group. ...
... 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 noninfected patients as well as mean preoperative ABI value. In contrast, Soares et al., reported mean preoperative ABI of 0.35 in noninfected patients (39% of cases with viable limbecategory Rutherford I) compared to mean ABI of 0.05 in patients with COVID-19. ...
... 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 2 times faster compared to noninfected cohort. This difference could be explained by the fact that 57% of the patients with SARS-CoV-2 infection developed ALI during in-hospital treatment for COVID-19. ...
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Introduction: A surge in the number of patients with acute limb ischemia (ALI) was seen during the first and second waves of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This has been ascribed to the hypercoagulable state seen in COVID infections. The aim of this study is to report our experience and outcomes of ALI associated with SARS-CoV-2 infection. Materials and Methods: It was a single-center observational retrospective study from a prospectively maintained database of patients with SARS-CoV-2 infection presenting with ALI between July 2020 and December 2020 with 1-year follow-up. Results: Thirty-nine acutely ischemic limbs were treated in 32 patients including three upper limbs. The mean age of patients was 55.75 (range: 27–80). There were 23 (71.87%) males and 9 (28.12%) females. Majority of the limbs were in Class IIB of ALI, whereas 20.51% had irreversible ischemia. Of the 39 affected limbs in 32 patients, 22 limbs were revascularized, 9 had primary amputation, and 8 were managed conservatively with anticoagulation. The overall limb salvage was 26 out of 39 limbs (66.7%), whereas it was 81.8% for the limbs that had an intervention. The overall mortality was 9.4%. There was no further limb loss or mortality during 1-year follow-up. Interestingly, 15 patients did not have any symptoms suggestive of SARS-CoV-2 infection other than ALI. The severity of COVID infection did not correlate with the severity of ALI. Conclusion: COVID-19 infection can be associated with arterial thrombosis and ALI, which, if treated early with appropriate intervention, can result in a satisfactory limb salvage rate. Prophylactic anticoagulation in COVID-19-infected patients may not prevent arterial thrombosis, and the clinical severity of the COVID-19 infection is not a predictor of arterial thrombosis.
