Limb Salvage after Covid-19 Related Major Arterial Thrombosis in an 81 -Year Lady with Critical Limb Ischemia: A Case Report

Abstract

Hypercoagulable state and thromboembolic events are common extra-pulmonary complications of COVID-19 that are increasingly reported in the literature. Unfortunately unlike VTE, no remarkable data are available on arterial thrombosis in SARS-CoV2 infected patients, and despite the use of anticoagulant and antiplatelet therapies, severe arterial thrombotic complications are observed. The objective of this case study is to share our experience about COVID-19 related peripheral arterial thrombosis and highlight the management plan of the resulting CLI in an elderly patient. It is a case report of an 81- year lady that developed fever, vomiting, and bone aches for 3 days before being transferred to the fever hospital with gastrointestinal upset, where she was admitted to normal ward and the diagnosis of COVID-19 was confirmed by RT-PCR. The patient improved and discharged to home after one week, 5 days later she started to complain of painful right foot then the pain involved the whole leg later on with fixed color changes and coldness, however, the diagnosis of acute ischemia was missed for one week more until the patient came to our department, and arterial duplex revealed extensive thrombosis of the SFA, popliteal and tibial arteries with CLI (ABI was<0.4). The patient was prepared for prompt vascular intervention and surgical embolectomy was performed via combined popliteal and femoral approaches. A long, thick, more gelatinous and darker thrombus was retrieved both proximally and distally. The limb was saved with fairly good distal runoff. Unfortunately, one week after the operation the patient slipped and developed fracture neck femur of the same limb, and she was operated on one month later. The patient had uneventful postoperative course, and such lucky 81years lady kept a viable well-functioning limb and could walk again. In conclusion, the key points of our case study include vigilant consideration of the arterial thrombosis in COVID-19 infected patients, routine monitoring of D-dimer levels with initiation of full-dose anticoagulation if levels elevated by six times the upper limit of normal, as well as prompt diagnosis of ALI, and urgent surgical revascularization to save the limb.