Acute Limb Ischemia Rutherford Classification III and COVID-19: A Case Report
DOI:
https://doi.org/10.31282/joti.v6n1.96Keywords:
Covid-19, Acute limb ischemia, Arterial thrombosis, AmputationAbstract
Background: COVID-19 is caused by SARS-CoV-2 infections, which are responsible for the recent pandemic. COVID-19 infection increases thromboembolic events, including Acute Limb Ischemia (ALI) by causing elevated cytokine levels, systemic inflammation, hypercoagulation state, and hyperinflammation responses. This complication might cause loss of limbs.
Case description: We report a case of a 61-year-old male with COVID-19 who developed an ALI. He presented to the emergency department with acute left leg pain since a day before admission and shortness of breath three days before
admission. His left foot was bluish-discolored, cold to the touch, and mottled in appearance. Chest x-ray showed bilateral inhomogeneous consolidation. Left lower limb X-ray revealed a gangrenous appearance. CT-Angiography suggested
severe distal stenosis of the left femoral artery with complete occlusion of its distal aspect. COVID-19 was diagnosed based on RT-PCR testing. He received antibiotics and anticoagulation. Unfortunately, he underwent an amputation procedure.
Conclusion: A high index of suspicion should be maintained for ALI in COVID-19 patients, which is a vascular emergency. Some patients can achieve revascularization with observation or medical and/or surgical intervention, but other patients succumb to either amputation or death.
Downloads
References
Sanchez JB, Alcalde JDC, Isdiro RR, et al. Acute Limb Ischemia in a Peruvian Cohort Infected by COVID-19. Annals of Vascular Surgery. 2021; 72: 196–204. DOI: 10.1016/j.avsg.2020.12.005
Vania, A., Yuliani, D., & Sumada, I.K. (2020). Manifestasi klinis neurologis pada COVID-19. Callosum Neurology Journal, 3:88-95. https://doi.org/10.29342/cnj.v3i3.118
World Health Organization. (2021a). Update on coronavirus disease in Indonesia. WHO. https://www.who.int/indonesia/news/novel-coronavirus
Gugus Tugas Percepatan Penanganan Covid-19. Pedoman Penanganan Cepat Medis dan Kesehatan Masyarakat Covid-19 di Indonesia. 2020;1–38.
Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New Engl J Med. 2020. DOI: 10.1056/NEJMoa2002032
PDPI. Pnemonia Covid-19. Diagnosis & Penatalaksanaan di Indonesia. 2020.
Bellosta R, Luzzani L, Natalini G, et al. Acute limb ischemia in patients with COVID-19 pneumonia. Journal of Vascular Surgery. 2020;72(6). DOI: 10.1016/j.jvs.2020.04.483
Topcu AC, Ariturk C, Yilmaz E. Acute limb ischemia in a COVID-19 patient. Thrombosis Update 2. 2021:100031 doi: 10.1016/j.tru.2020.100031
Natarajan B, Patel P, Mukherjee A. Acute Lower Limb Ischemia—Etiology, Pathology, and Management. Int J Angiol. 2020;29:168–174. DOI: 10.1055/s-0040-1713769
Galyfos G, Sianou A, Frountzas M, et al. Acute limb ischemia among patients with COVID-19 infection. Journal of Vascular Surgery. 2022;75(1):326-342 DOI: 10.1016/j.jvs.2021.07.222
Kinlay S. Management of critical limb ischemia. Circ Cardiovasc Interv. 2016; 9(2): e001946. DOI: 10.1161/CIRCINTERVENTIONS.115.001946
