Patients with acute respiratory distress syndrome due to infection with the novel coronavirus SARS-COV2 are currently considered at high risk of developing thromboembolic complications in both venous and arterial vessels. The use of anticoagulants for preventive or curative purposes should be considered to reduce the risk of thromboembolic events. We report a case of a patient with severe COVID-19 acute respiratory distress syndrome who consecutively developed a right femoral deep vein thrombosis related to the femoral central line and acute ischemia of the left upper limb related to a radial arterial line. He was under a therapeutic dose of low molecular weight heparin twice a day three days before. The femoral vein was free of thrombosis while the central line was placed under a duplex ultrasound. Thromboembolic events can occur in patients with severe COVID-19 despite therapeutic anticoagulants. Close monitoring of vascular access with duplex ultrasound may be required.

This contribution is being co-published in the following journals: Journal of Hypertension and Vascular Medicine. There will be minor differences in the version published in Vascular Medicine due to copy-editing differences.

Pulmonary embolism (PE) represents the third leading cause of cardiovascular mortality. The technological landscape for management of acute intermediate- and high-risk PE is rapidly evolving. Two interventional devices using pharmacomechanical means to recanalize the pulmonary arteries have recently been cleared by the US Food and Drug Administration for marketing, and several others are in various stages of development. The purpose of this document is to clarify the current state of endovascular interventional therapy for acute PE and to provide considerations for evidence development for new devices that will define which patients with PE would derive the greatest net benefit from their use in various clinical settings. First, definitions and limitations of commonly used risk stratification tools for PE are reviewed. An adjudication of risks and benefits of available interventional therapies for PE follows. Next, considerations for optimal future evidence development in this field are presented in the context of the current US regulatory framework. Finally, the document concludes with a discussion of the pros and cons of the rapidly expanding PE response team model of care delivery.

AASLD ¼ American Association for the Study of Liver Disease, aPTT ¼ activated partial thromboplastin time, CI ¼ confidence interval, CVC ¼ central venous catheter, DAPT ¼ dual antiplatelet therapy, DOAC ¼ direct oral anticoagulant, DVT ¼ deep vein thrombosis, FFP ¼ fresh frozen plasma, INR ¼ International Normalized Ratio, LMWH ¼ low molecular weight heparin, NVAF ¼ nonvalvular atrial fibrillation, PEG ¼ percutaneous endoscopic gastrostomy, PT ¼ prothrombin time, RCT ¼ randomized controlled trial, VKA ¼ vitamin K antagonist, VTE ¼ venous thromboembolism