Acute Limb Ischemia in Hospitalized COVID-19 Patients

Autor: Recep Demirhan, Ayse Batirel, Gozde Ozturk-Altunyurt, Dilara Akman, Ahmet Can Topcu
Rok vydání: 2021
Předmět:
Male
medicine.medical_specialty
Time Factors
Cross-sectional study
medicine.drug_class
medicine.medical_treatment
Ischemia
Low molecular weight heparin
030204 cardiovascular system & hematology
Risk Assessment
Amputation
Surgical
Clinical Research
Basic Science
030218 nuclear medicine & medical imaging
law.invention
Peripheral Arterial Disease
03 medical and health sciences
0302 clinical medicine
Risk Factors
law
Internal medicine
Humans
Medicine
Hospital Mortality
Aged
Retrospective Studies
Thrombectomy
Computed tomography angiography
medicine.diagnostic_test
business.industry
Anticoagulants
COVID-19
Retrospective cohort study
General Medicine
Middle Aged
Limb Salvage
medicine.disease
Intensive care unit
Thrombosis
Patient Discharge
Hospitalization
Cross-Sectional Studies
Treatment Outcome
Amputation
Acute Disease
Female
Surgery
Cardiology and Cardiovascular Medicine
business
Zdroj: Annals of Vascular Surgery
ISSN: 0890-5096
DOI: 10.1016/j.avsg.2021.03.003
Popis: Background COVID-19 is a multisystemic disorder. Hematologic and cardiovascular involvement of COVID-19 causes thromboembolic events across multiple organs which mainly manifest as venous thromboembolism, and rarely, peripheral arterial thromboembolic events. In-situ thrombosis of a healthy, non-atherosclerotic native artery is rare, and COVID-19 has been reported to be a cause of this phenomenon. We aimed to report our institutional experience with COVID-19 patients who developed acute limb ischemia (ALI) during hospitalization or after discharge. Methods This was a single-center cross-sectional study. Records of all patients ≥18 years of age admitted to a tertiary center with a confirmed diagnosis of COVID-19 infection between September 1 and December 31, 2020 were retrospectively examined. Data regarding patient demographics, co-morbidities and outcomes were collected. Patients were followed-up during index hospitalization and for 30 days postdischarge. Acute limb ischemia was diagnosed by means of duplex ultrasound and computed tomography angiography in the presence of a clinical suspicion. Results A total of 681 consecutive patients (38.5% women) were hospitalized with a confirmed diagnosis of COVID-19 during the study period. Median age was 63 years (IQR, 52–74). In-hospital mortality occurred in 94 (13.8%) patients. Ninety (13.2%) patients required intensive care unit admission at some point of their hospital stay. Six (0.9%) patients (one woman) with a median age of 62 years experienced ALI (IQR, 59–64.3). All patients were receiving low molecular weight heparin when they developed ALI. The median of duration between COVID-19 diagnosis and ALI symptom onset was 13 days (IQR, 11.3–14). Three patients underwent emergent surgical thrombectomy combined with systemic anticoagulation, and 3 received systemic anticoagulation alone. Two patients with ALI did not survive to hospital discharge. Among survivors, 1 patient underwent bilateral major amputations, and another underwent a minor amputation within 1 month of hospital discharge. Symptoms of ALI completely resolved in 2 patients without sequelae. Conclusions COVID-19 is a multisystemic disorder with involvement of hematologic and cardiovascular systems. Despite widespread use of thromboprophylaxis, hospitalized patients with COVID-19 are at increased risk of ALI, and subsequent limb loss or even death.
Databáze: OpenAIRE
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