A clinical case series of COVID-19-associated acute limb ischemia: real-world situation

Surya S.P., Santoso R.M.

Primaya Hopsital Tangerang, Jl. MH. Thamrin no.3, Kebon Nanas, Cikokol, Tangerang, Indonesia; Department of Cardiology and Vascular Medicine, Primaya Hospital Tangerang, Tangerang, Indonesia


Abstract

Background: COVID-19 was a trending topic all year long in 2020. Currently, it is not only a problem for a pulmonologist since it could cause complications to many other organs, including the cardiovascular system. Recent acute COVID-19 infection state has been associated with hypercoagulation and causing microthrombi called immunothrombus. Acute limb ischemia is one of the rare complications but organ-threatening. Unfortunately, unlike coronary artery disease, there is no recent guideline for cardiologists to diagnose and manage acute limb ischemia in pandemic situations Case presentation: This case series presented two patients with acute limb injury (ALI)-complicating COVID-19, with chief complaints of pain at their lower extremity. The first patient was an 80-year-old woman who was just dismissed from the hospital due to COVID-19. The distal part of her toe was cyanosed, and her motoric and sensory functions were partially reduced. She was treated with oral drug therapy due to unwillingness to be hospitalized. Interestingly, she had recovered by using oral drug therapy. The second case was a 54-years-old female with several comorbidities such as obesity, type 2 diabetes mellitus, hypertension, dyslipidemia, and chronic obstructive pulmonary disease. She had cyanosed foot and weak arterial pulsation. Unfortunately, she passed away due to acute respiratory distress syndrome. Conclusion: Several internal and external factors cause ALI treatment to be more challenging in the pandemic COVID-19 situation. The diagnosis and management of ALI in COVID-19 patients may not fully comply with the current guideline and are likely to be affected by local hospital regulations. Clinical follow-up might be an essential feature in treating ALI in COVID-19 patients. © 2021, The Author(s).

Acute limb ischemia; Case report; COVID-19; COVID-19-associated coagulopathy; Immunothrombus


Journal

Egyptian Heart Journal

Publisher: Springer Science and Business Media Deutschland GmbH

Volume 73, Issue 1, Art No 59, Page – , Page Count


Journal Link: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85108911942&doi=10.1186%2fs43044-021-00187-0&partnerID=40&md5=36564fd05a6c4aaf773ae70f71ca74fa

doi: 10.1186/s43044-021-00187-0

Issn: 11102608

Type: All Open Access, Gold, Green


References

Reese, H., Danielle Iuliano, A., Patel, N.N., Grag, S., Kim, L., Silk, B.J., Estimated incidence of COVID-19 illness and hospitalization (2020) Clin Infect Dis Ciaa1780, , United States; Binns, C., Low, W.Y., Kyung, L.M., The COVID-19 pandemic: public health and epidemiology (2020) Asia Pac J Public Health, 32 (4), pp. 140-144; Mokhtari, T., Hassani, F., Ghaffari, N., Ebrahimi, B., Yarahmadi, A., Hassanzadeh, G., COVID-19 and multiorgan failure: A narrative review on potential mechanisms (2020) J Mol Histol, pp. 1-16; Laksono, S., Setianto, B., Surya, S.P., Angiotensin converting enzyme 2 (ACE2), COVID-19, and cardiac injury: what cardiologist should know (2020) J Med Sci, 3 (SI), pp. 105-110; Nishiga, M., Wang, D.W., Han, Y., Lewis, D.B., WU, J., COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives (2020) Nat Rev Cardiol, 17 (9), pp. 543-558; Goldman, I.A., Ye, K., Scheinfeld, M.H., Lower-extremity arterial thrombosis associated with COVID-19 is characterized by greater thrombus burden and increased rate of amputation and death (2020) Radiology., 297 (2), pp. E263-E269; Bellosta, R., Luzzani, L., Natalini, G., Pegorer, M.A., Attisani, L., Cossu, L.G., Acute limb ischemia in patients with COVID-19 pneumonia (2020) J Vasc Surg, 72 (6), pp. 1864-1872; Olinic, D.M., Stanek, A., Tataru, D.A., Homorodean, C., Olinic, M., Acute limb ischemia: an update on diagnosis and management (2019) J Clin Med, 8 (8), p. 1215; Gubitosa, J.C., Xu, P., Ahmed, A., Pergament, K., COVID-19 associated acute limb ischemia in a patient on therapeutic anticoagulant (2020) Cureus., 12 (9); Aboyans, V., Ricco, J.B., Bartelink, M.E.B.L., Bjorck, M., Brodmann, M., Cohnert, T., ESC Guidelines on the diagnosis and treatment of peripheral arterial disease, in collaboration with the European Society for Vascular Surgery (ESVS) (2017) Eur J Vasc Endovasc Surg, 2018 (55), pp. 305-368; Gerhard-Herman, M.D., Gornik, H.L., Barret, C., Barshes, N.R., Corriere, M.A., Crachman, D.E., 2016 AHA/ACC Guideline on the management of patient with lower extremity peripheral artery disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines (2017) Circulation., 135 (12), pp. e686-e725; Bjorck, M., Earnshaw, J.J., Acosta, S., Goncalves, F.B., Cochennec, F., Debus, E.S., European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischemia (2020) Eur J Vasc Endovasc Surg, 59 (2), pp. 173-218; Klok, F.A., Kruip, M.J.H.A., van der Meer, N.J.M., Arbous, M.S., Gommers, D.A.M.P.J., Kant, K.M., Kaptein, F.H.J., Endeman, H., Incidence of thrombotic complication in critically ill ICU patients with COVID-19 (2020) Thromb Res, 191, pp. 145-147; Jayarangaiah, A., Kariyanna, P.T., Chen, X., Jayarangaiah, A., Kumar, A., COVID-19-associated coagulopathy: an exacerbated immunothombosis response (2020) Clin Appl Thromb Hemost, 26. , COI: 1:CAS:528:DC%2BB3MXks1Cnug%3D%3D,1076029620943293; Loof, T.G., Morgelin, M., Johansson, L., Oehmcke, S., Olin, A.I., Dickneite, G., Coagulation, an ancestral serine protease cascade, exerts a novel function in early immune defense (2011) Blood., 118 (9), pp. 2589-2598; Swystun, L.L., Liaw, P.C., The role of leucocytes in thrombosis (2016) Blood, 128 (6), pp. 753-762. , COI: 1:CAS:528:DC%2BC28XhslOktbzO; Boroujeni, A.S., Sani, M.R.M., Anti-inflmmatory potential of quercetin in COVID-19 treatment (2021) J Inflamm, 18 (3); Castejon, G.L., Brough, D., Understanding the mechanism of IL-1ß secretion (2011) Cytokine Growth Factor Rev, 22 (4), pp. 189-195; Grillet, F., Behr, J., Calame, P., Aubry, S., Delabrousse, E., Acute pulmonary embolism associated with COVID-19 pneumonia detected with pulmonary CT-angiography (2020) Radiology., 296 (3), pp. E186-E188; Champbell, C.M., Kahwash, R., Will complement inhibition be the new target in treating COVID-19 related systemic thrombosis? (2020) Circulation., 141 (22), pp. 1739-1741; Goeijenbier, M., van Wissen, M., van de Weg, C., Jong, E., Gerdes, V.E.A., Miejers, J.C.M., Review: viral infections and mechanisms of thrombosis and bleeding (2012) J Med Virol, 84 (10), pp. 1680-1696; Esmon, C.T., The interactions between inflammation and coagulation (2005) Br J Haematol, 131 (4), pp. 417-430; Weiss, C.R., Azene, E.M., Majdalany, B.S., AbuRahma, A.F., Collins, J.D., Francois, C.J., ACR appropriateness criteria sudden onset of cold, painful leg (2017) J Am Coll Radiol, 14 (5S), pp. 2307-2313

Indexed by Scopus

Leave a Comment