Acute Limb Ischemia in COVID-19 Disease: A Mysterious Coagulopathy

Abstract

Severe coronavirus disease 2019 (COVID-19) as a respiratory tract infection has been noted to be a causative agent for acute respiratory distress syndrome, shock, and multiple organ failure. It is also being suggested that COVID-19 results in serious systemic coagulopathies similar to disseminated intravascular coagulation. We describe a case of severe arterial thrombosis induced by COVID-19 infection along with its pathological implications.

Acute Limb Ischemia in a Peruvian Cohort Infected by COVID-19

“…7,31 Distributed between short and isolated records, more frequent arterial involvement was shown in the lower limbs, predominantly the popliteal, anterior and posterior tibial, superficial femoral, iliac, and distal aorta. 7,12,23,24,26,28,[32][33][34] This distribution coincides with our findings where these arteries were mainly counting about 50% of the total of vessels involved.…”

“…18,21,22 ALI in COVID-19 can occur in two situations. During the in-hospital evolution of severe COVID-19 infection 6,[23][24][25][26] , Zhan et al has reported a median of 19 (11-23 days) from the appearance of symptoms of the infection to the installation of ischemia 27 or they can be admitted to the emergency room for this vascular condition with mild or no respiratory symptoms. [28][29][30] We report an ischemic time of 39 hours, defined from the apparent onset of symptoms to surgical intervention.…”

“…28 Other treatments described were angioplasties with or without a stent or bypass. 6,26 Recently published studies, mostly from Asia, Europe, and the United States, have usually described venous involvement above the arterial since the beginning of the pandemic. 7,31 Distributed between short and isolated records, more frequent arterial involvement was shown in the lower limbs, predominantly the popliteal, anterior and posterior tibial, superficial femoral, iliac, and distal aorta.…”

Axillary artery thrombosis resulting in upper limb amputation as a COVID-19 sequela

“…The interleukin 6-related inflammatory storm stimulates the liver to produce fibrinogen and thrombopoietin, and also disrupts the endothelium of the vessels leading to activation of the extrinsic pathway of coagulation, causing catastrophic thrombotic events. 12 Though literature reports ischaemia related to COVID-19, more commonly in the lower limb, there are very few reports of upper limb involvement. 13 Even with prophylactic or therapeutic anticoagulation, thrombosis rates are found to be high.…”

Renal artery thrombosis in COVID-19

“…Since the emergence of global pandemic of the novel coronavirus (COVID-19) in China in December 2019, it has been described as a causative agent for spectrum of clinical pathologies (acute respiratory distress syndrome, shock, multi-organ failure). Clinical practice and data have suggested that COVID-19 is producing severe hypercoagulability state in patients leading to both venous and arterial thromboembolic events such as pulmonary embolism, stroke and limb ischemia ( [1] , [2] , [3] , [4] ).…”