Acute limb ishemia associated with severe acute respiratory syndrome coronavirus 2 infection

Abstract

Introduction. Severe acute respiratory syndrome coronavirus 2 infection-induced coagulopathy may be the underlying cause of acute limb ischemia, a sudden decrease in limb perfusion. The aim of this study was to present a case series of acute limb ischemia associated with severe acute respiratory syndrome coronavirus 2 infection. Material and Methods. This unicentric, observational cohort study evaluated the incidence, risk factors, clinical, laboratory and radiological findings, problems in diagnosis, treatment and outcome of patients with severe acute respiratory syndrome coronavirus 2 infection-induced acute limb ischemia. Results. The study included 14 patients with a diagnosis of severe acute respiratory syndrome coronavirus 2 infection-induced acute limb ischemia in a 20-month period. The majority of patients were male (78.6%), with a mean age of 67 years, body mass index > 30, and typical cardiovascular risk factors. Only 64.3% of acute limb ischemia patients with coronavirus disease 2019 underwent attempts of limb salvage; 14.3% required primary amputation; 21.4% were treated with systemic anticoagulant therapy alone. The mortality rate was high (42.9%). Revascularization was successful in 7 (50%) patients with acute limb ischemia. The overall amputation rate was 28.6%. Conclusion. The high incidence of acute limb ischemia associated with severe acute respiratory syndrome coronavirus 2 infection, even with thromboprophylaxis, high mortality rates and poor limb salvage outcomes, encourage clinicians to apply individually tailored diagnostic and therapeutic approaches. Prolonged systemic use of heparin may improve the effectiveness of surgical treatment, limb salvage, and overall survival.