C6. Acute Limb Ischemia Patient with Covid 19 Progressing to Chronic Limb-Threatening Ischemia: a Case Report

Abstract

Abstract Background Acute Limb Ischemia (ALI) and Chronic Limb-Threatening Ischemia (CLTI) are manifestations of Peripheral Artery Disease (PAD). The management of ALI and CLTI, apart from optimal medical treatment and lifestyle control, also includes surgery and endovascular revascularization. ALI and CLTI conditions can be a thromboembolic complication of Covid 19. Case Description A 58-year-old woman with risk factor Diabetes Mellitus presents with a black leg on the digiti I and digiti II of the right inferior extremity. She also complains of walking pain for 2 months. Previously, She had been treated with complaints of ischemic leg pain 2 months earlier and had performed a Doppler Ultrasound. At that time, she was diagnosed as ALI Grade II-A and was positive for Covid 19, from the laboratory examinations it was found an increase in fibrinogen, 419 mg/dl (Reference value 154.3-397.9) and D-Dimer increased to 0.9 mg/L (Reference value ≤ 0.5), She had undergone a surgical embolectomy procedure. At the time of the last control and based on CT-angiography, she was assessed as CLTI with Fontaine IV, Rutherford V, WIfI 1-1-0 and decided to do endovascular revascularization. Discussion The choice of either a surgical procedure or endovascular revascularization depends on grading and the initial assessment. Correct timing of ALI and CLTI treatment will increase limb salvage rate. Covid 19 can also manifest as a condition associated with a hypercoagulable state that can, in turn, lead to both arterial and venous thrombosis.