Cardiovascular examination should also include peripheral arterial evaluation for COVID-19 patients

Abstract

Recently, a small number of patients have presented with systemic intra-arterial thrombosis and a diagnosis of SARS-CoV-2. There is some evidence to suggest that this may occur, with a small series reporting ischemic strokes in patients in intensive care units. 5 In our experience, patients presenting with limb-threatening ischemia and SARS-CoV-2 have had no other clear reason for development of intra-arterial thrombosis. Management has been dictated primarily by the severity of the organ dysfunction. A conservative approach with the prescription of therapeutic low-molecular-weight-heparin with subsequent conversion to a direct-acting oral anticoagulant has been an effective strategy.Vascular surgeons have to recognize the potential for limb-and life-threatening arterial occlusion events in patients with SARS-CoV-2. Further research is required to try to elucidate the mechanisms by which this disease process activates the coagulation cascade.

Arterial Thrombosis in Coronavirus Disease 2019 Patients: A Rapid Systematic Review

“…Five cohort studies ( n = 537 patients) reported data on the incidence of AT in severe/critically ill ICU-admitted COVID-19 patients, with the incidence ranging from 2.7%–8%. 11 , 19 , 24 , 28 , 34 The pooled incidence of AT across these 5 studies was 4.4% (95% confidence interval 2.8–6.4), with no interstudy heterogeneity observed (I2 = 0%, Cochran's Q = 3.908; P = 0.419; Fig. 2 ).…”

“…A total of 27 studies describing arterial thrombotic events in 90 COVID-19 patients were included. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 The majority of the studies were from Europe (23 studies; France: 8, Italy: 7, Spain: 4, the United Kingdom: 3, and the Netherlands: 1), whereas the rest were from North America (the United States of America: 3 and Canada: 1). Of the included studies, 5 were cohort, 5 were case series, and the rest were case reports.…”

“… 27 , 31 It was symptomatic in the rest, manifesting as acute limb ischemia, 11 , 12 , 18 , 19 , 21 , 24 , 25 , 26 , 30 , 32 , 35 , 37 acute cerebral ischemia, 11 , 13 , 14 , 15 , 19 , 21 , 22 , 24 , 28 , 29 acute mesenteric ischemia, 14 , 16 , 17 , 19 , 24 , 37 and acute myocardial ischemia. 19 , 23 , 33 , 34 …”

“… 33 Spain Case report 1 1 (100) 59 1 (100) Cardiac (left and right coronary arteries) Coronary angiography None HTN, DM 0 (0) Thomas et al. 34 UK Cohort 63 2 (3) - - Heart (coronary artery) Coronary angiography Not reported Not reported Not reported Valdivia et al. 35 Spain Case series 4 4 (100) 53, 70, 72, 72 - Lower limb (iliac artery and infrainguinal arteries) Not reported None COPD, DM, HTN 1 (25) Viguier et al.…”

Adapting Vascular Surgery Practice to the Current COVID-19 Era at a Tertiary Academic Center in Madrid

“…Since the first case detected in late 2019 in China, a fast worldwide expansion confirms it. The current knowledge of the disease describes mostly on a severe acute respiratory syndrome (SARS-CoV-2) while many other clinical descriptions of the disease have also been reported, such as peripheral arterial thrombosis, 1,2 myocarditis, or central nervous system affections.…”