Peripheral artery disease, the ‘lost syndrome’ during lockdown for COVID‑19: A report of three cases

Abstract

the recent coronavirus disease 2019 pandemic has significantly increased the burden placed on healthcare systems worldwide. This health emergency has led to changes being implemented in the organization of health institutions and has shifted the focus on pandemic management. This has led to marked changes being made in the treatment of patients without COVID-19, and has resulted in more difficult access to healthcare, with ensuing delays in diagnosis and treatment. Vascular diseases, including peripheral artery disease (PAD), require prompt treatment in the majority of cases in order to save affected limbs. Moreover, COVID-19 may result in acute arterial and venous complications, which need to be promptly recognized and treated. The present study describes three paradigmatic clinical cases of hospitalized patients, which are representative of the different forms of the 'lost syndrome' caused by either the direct effect of COVID-19 or by the effects of COVID-19 on the healthcare system and lifestyle factors. Prophylaxis against arterial and venous thrombotic events is crucial in patients with COVID-19, particularly those with a marked inflammatory state. On the other hand, the CoVID-19 pandemic has diminished the access to healthcare system for patients with other chronic pathologies, with potential severe consequences for vulnerable patient groups, such as those with PAD and cardiovascular diseases. For these patients, the authors' experience over the last few months suggests that more suitable measures need to be adopted to avoid additional severe consequences on public health. In addition, it is necessary to identify pathways that will allow these patients to have rapid access to treatment with marked improvements in outcome.

Distinct Features of Vascular Diseases in COVID-19

“… 146 , 147 The COVID-19 pandemic, the lockdowns, and social distancing together or separately 1) limited PAD diagnosis, 2) delayed its treatment, and 3) increased the prevalence of the disease. 93 , 148 , 149 …”

“…Inhibition of endogenous anticoagulant proteins and an increase in plasminogen activator inhibitor I and tissue factor were involved. 148 , 154 , 155 …”

“…146,147 The COVID-19 pandemic, the lockdowns, and social distancing together or separately 1) limited PAD diagnosis, 2) delayed its treatment, and 3) increased the prevalence of the disease. 93,148,149 The relationship between PAD and COVID-19 and whether its co-prevalence leads to worse outcomes is still under investigation. Nevertheless, PAD patients with COVID-19 have a 40% greater rate of major adverse cardiovascular events compared to PAD patients without COVID-19.…”

Cardiac Rehabilitation in Patients with Peripheral Artery Disease—A Literature Review in COVID-19 Era

“…SARS-CoV2 infection causes the appearance of a pro-inflammatory status accompanied by cytokine storms that cause secondary vascular inflammation and endothelial dysfunction. SARS-CoV2 infection can cause arterial and venous thromboembolic complications in patients with previous CVD [39][40][41]. Patients with PAD and COVID-19 may develop acute limb ischemia secondary to thrombosis of the aorta or peripheral arteries secondary to endothelial dysfunction [41,42].…”

“…SARS-CoV2 infection can cause arterial and venous thromboembolic complications in patients with previous CVD [39][40][41]. Patients with PAD and COVID-19 may develop acute limb ischemia secondary to thrombosis of the aorta or peripheral arteries secondary to endothelial dysfunction [41,42]. Both PAD and COVID-19 causes hypercoagulability, but it is currently not well defined whether PAD patients associate worse outcomes when infected with SARS-CoV2.…”