COVID-associated acute limb ischemia during the Delta surge and the effect of vaccines

Xie, Bowen; Semaan, Dana B.; Binko, Mary A.; Agrawal, Nishant; Kulkarni, Rohan; Andraska, Elizabeth; Sachdev, Ulka; Chaer, Rabih A.; Eslami, Mohammad H.; Makaroun, Michel S.; Sridharan, Natalie

doi:10.1016/j.jvs.2022.12.002

Cited by 6 publications

(16 citation statements)

References 27 publications

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“…However, the single case of AT consequently received an AKA, showing that the 30-day outcomes remain poor. To our knowledge, there has only been one other study comparing the incidence of ALI in vaccinated and unvaccinated patients [ 14 ]. Bowen Xie et al observed that COVID-19-associated limb ischaemia predominately affected non-vaccinated patients, accounting for 92% of cases.…”

Section: Discussionmentioning

confidence: 99%

The Mysterious Risk of Arterial Thrombosis With COVID-19: A Case Series of Acute Limb Ischaemia in Vaccinated Patients

Sanders,

Stather,

Al-Jundi

2024

Cureus

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Introduction Coronavirus-19 (COVID-19) plays a vital role in viral-induced hypercoagulability through the initiation of a cytokine storm. This mechanism has been found to predispose unvaccinated patients to systemic complications including arterial thrombosis (AT) with poor 30-day amputation-free survival rates. There remains, however, little understanding regarding the incidence in patients who have received a COVID-19 vaccination. This study aims to assess the incidence, management and outcomes of vaccinated patients with COVID-19 who develop thrombotic complications to reduce amputation and direct mortality. Methods The case notes of all emergency patients with COVID-19 referred to the vascular services in a tertiary referral centre between November 2021 and April 2022 were reviewed. Patients who were unvaccinated or admitted with stroke or coronary thrombosis were excluded. The study was undertaken to measure 30-day outcomes. Results Between November 2021 and April 2022, 167,290 people tested positive for COVID-19 in Norfolk. Thirty-one patients under the vascular service had COVID-19, of which, one patient was unvaccinated. Only one vaccinated patient was referred with AT and had a positive COVID-19 result two days after admission. Above-knee amputation was performed within 30 days and he survived. Seventeen percent of patients contracted COVID-19 during their hospital admission. Conclusion The incidence of acute limb ischaemia in vaccinated patients is low; however, the 30-day outcomes remain poor. Compared to unvaccinated patients, there was a significant reduction in the presentation of AT in vaccinated patients during that timeframe, despite a higher background number of COVID-19 cases. Therefore, vaccination may minimise the risk of AT.

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Section: Discussionmentioning

confidence: 99%

The Mysterious Risk of Arterial Thrombosis With COVID-19: A Case Series of Acute Limb Ischaemia in Vaccinated Patients

Sanders,

Stather,

Al-Jundi

2024

Cureus

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“…The systematic review of the literature collected 11 different studies, for a total of 15,803 patients. Seven of these were retrospective studies [22,[27][28][29][30][31][32], three were prospective [33][34][35], while one [36] was a prospective study that included a comparison group formed by a retrospectively collected cohort.…”

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 99%

“…Five studies [27,29,31,32,36] included as a comparison group a cohort of pre-COVID patients, who had been treated for ALI in the period between 2017 and 2019. Four further studies, [22,30,33,34] considered for comparisons negative patients treated concurrently as COVID-19-positive patients.…”

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 99%

“…A high range of geographical heterogeneity was found throughout the studies, as they were conducted across five different continents (five in North America [22,[27][28][29]32], three in Europe [34][35][36], one in South America [33], one in Africa [30], and one in Asia [31]).…”

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 99%

“…More than one half of the studies (7 out of 11) included patients admitted to single specialized/tertiary vascular or trauma medical centers [27][28][29][30]33,35,36], whereas in one study, data were collected from a network of four regional vascular surgery hubs [34]. In three further studies, data were extracted from electronic medical records from networks of healthcare organizations [22,32] or obtained from medical records of two tertiary vascular centers [31].…”

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 99%

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The Impact of COVID-19 on Amputation and Mortality Rates in Patients with Acute Limb Ischemia: A Systematic Review and Meta-Analysis

Crupi,

Ardizzone,

Calapai

et al. 2024

Diseases

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Since the inception of the SARS-CoV-2 pandemic, healthcare systems around the world observed an increased rate of Acute Limb Ischemia (ALI) in patients with a COVID-19 infection. Despite several pieces of evidence suggesting that COVID-19 infection may also worsen the prognosis associated with ALI, only a small number of published studies include a direct comparison regarding the outcomes of both COVID-19 and non-COVID-19 ALI patients. Based on the above, a systematic review and a meta-analysis of the literature were conducted, evaluating differences in the incidence of two major outcomes (amputation and mortality rate) between patients concurrently affected by COVID-19 and negative ALI subjects. PubMed (MEDLINE), Web of Science, and Embase (OVID) databases were scrutinized from January 2020 up to 31 December 2023, and 7906 total articles were recovered. In total, 11 studies (n: 15,803 subjects) were included in the systematic review, and 10 of them (15,305 patients) were also included in the meta-analysis. Across all the studies, COVID-19-positive ALI patients experienced worse outcomes (mortality rates ranging from 6.7% to 47.2%; amputation rates ranging from 7.0% to 39.1%) compared to non-infected ALI patients (mortality rates ranging from 3.1% to 16.7%; amputation rates ranging from 2.7% to 18%). Similarly, our meta-analysis shows that both the amputation rate (OR: 2.31; 95% CI: 1.68–3.17; p < 0.00001) and mortality (OR: 3.64; 95% CI: 3.02–4.39; p < 0.00001) is significantly higher in COVID-19 ALI patients compared to ALI patients.

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Outcomes of Surgical Revascularization for Acute Limb Ischemia in COVID-19 Patients Comparing to Noninfected Cohort: A Single-Center Observational Prospective Study

Predenciuc

Casian

Culiuc

2023

Annals of Vascular Surgery

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COVID-associated acute limb ischemia during the Delta surge and the effect of vaccines

Cited by 6 publications

References 27 publications

The Mysterious Risk of Arterial Thrombosis With COVID-19: A Case Series of Acute Limb Ischaemia in Vaccinated Patients

The Mysterious Risk of Arterial Thrombosis With COVID-19: A Case Series of Acute Limb Ischaemia in Vaccinated Patients

The Impact of COVID-19 on Amputation and Mortality Rates in Patients with Acute Limb Ischemia: A Systematic Review and Meta-Analysis

Outcomes of Surgical Revascularization for Acute Limb Ischemia in COVID-19 Patients Comparing to Noninfected Cohort: A Single-Center Observational Prospective Study

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