Background Coronavirus disease 2019 (COVID-19) predisposes to arterial and venous thromboembolic complications. We describe the clinical presentation, management, and outcomes of acute arterial ischemia and concomitant infection at the epicenter of cases in the United States. Methods Patients with confirmed COVID-19 infection between March 1, 2020 and May 15, 2020 with an acute arterial thromboembolic event were reviewed. Data collected included demographics, anatomical location of the thromboembolism, treatments, and outcomes. Results Over the 11-week period, the Northwell Health System cared for 12,630 hospitalized patients with COVID-19. A total of 49 patients with arterial thromboembolism and confirmed COVID-19 were identified. The median age was 67 years (58–75) and 37 (76%) were men. The most common preexisting conditions were hypertension (53%) and diabetes (35%). The median D-dimer level was 2,673 ng/mL (723–7,139). The distribution of thromboembolic events included upper 7 (14%) and lower 35 (71%) extremity ischemia, bowel ischemia 2 (4%), and cerebral ischemia 5 (10%). Six patients (12%) had thrombus in multiple locations. Concomitant deep vein thrombosis was found in 8 patients (16%). Twenty-two (45%) patients presented with signs of acute arterial ischemia and were subsequently diagnosed with COVID-19. The remaining 27 (55%) developed ischemia during hospitalization. Revascularization was performed in 13 (27%) patients, primary amputation in 5 (10%), administration of systemic tissue‐ plasminogen activator in 3 (6%), and 28 (57%) were treated with systemic anticoagulation only. The rate of limb loss was 18%. Twenty-one patients (46%) died in the hospital. Twenty-five (51%) were successfully discharged, and 3 patients are still in the hospital. Conclusions While the mechanism of thromboembolic events in patients with COVID-19 remains unclear, the occurrence of such complication is associated with acute arterial ischemia which results in a high limb loss and mortality.

Small or suboptimal veins can undergo PBA and then be matured to create functioning AVFs 90% autogenous AVF rates can be achieved using PBA and BAM. BAM can be successfully used to mature AVFs created from small veins and salvage thrombosed AVFs in many cases. The use of these techniques may decrease the number of patients requiring AVGs and indwelling catheters.

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Conclusions:In the LE group there were significantly more complications, greater mean overall hospital and ICU length of stay and higher mortality. Lower extremities required more intensive intervention compared to upper extremities: there were more fasciotomies, complex soft tissue repairs and major amputations performed. Those patients with blunt mechanism of injury, regardless of the extremity, also had higher rates of these procedures as well as significantly higher complication and mortality rates compared to those with penetrating injury.

microemboli was significantly higher in CAS group than CEA group (46.3% and 12% respectively, PϽ0.05) despite a relative low incidence of associated neurologic symptoms (2.6 % vs. 2%). Thirty patients (16 CAS and 14 CEA) with 50 DWI lesions (mean size 46.57mm 2 , ranging 16 to 128mm 2 ) were further analyzed. During a mean MRI follow-up of 10 months (range, 2 to 23 months), residual MRI abnormalities were only identified in DWI lesions larger than 60mm 2 (nϭ5, PϽ0.001). CEA group had fewer but larger ipsilaterally distributed emboli (total 12 lesions, mean 79mm 2 ) comparing to CAS group (total 38 lesions, mean 27.5mm 2 , PϽ0.05). Regression analyses of 68 CAS patients (mean age 71 years, range, 53-91 years) showed that date of procedure prior to 1/2007, coronary artery disease, diabetes, and perioperative troponin elevation were significant predictors of microemboli (PϽ0.03). Date of procedure was the only predictor of bilateral hemispheres microemboli (pϭ0.025).Conclusions: Carotid interventions are associated with significant DWI lesions despite absence of clinical symptoms. Risks of microemboli correlate to physician experience and patient selection. Larger DWI lesions (Ͼ60mm 2 ) can lead to long-term residual structure abnormalities that warrants further neurocognitive evaluation.