A review of acute limb ischemia in COVID-positive patients

Giovanni Tinelli, Nicole Ilonzo, Dejah Judelson, Wissam Al-Jundi, Yana Etkin, Leigh Anne O'Banion, Aksim Rivera, Rafaello Bellosta, Ageliki Vouyouka

Research output: Contribution to journalArticle

Abstract

This literature review discusses the current evidence on acute limb ischemia (ALI) in patients with COVID-19. Throughout the pandemic, these patients have been at increased risk of arterial thrombotic events and subsequent mortality as a result of a hypercoagulable state. The exact mechanism of thrombosis is unknown; however arterial thrombosis may be due to invasion of endothelial cells via angiotensin-converting enzyme 2 (ACE2) receptors, endothelial injury from inflammation, or even free-floating aortic thrombus. Multiple studies have been performed evaluating the medical and surgical management of these patients; the decision to proceed with operative intervention is dependent on the patient's clinical status as it relates to COVID-19 and morbidity of that disease. The interventions afforded typically include anticoagulation in patients undergoing palliation; alternatively, thrombectomy (endovascular and open) is utilized in other patients. There is a high risk of rethrombosis, despite anticoagulation, given persistent endothelial injury from the virus. Postoperative mortality can be high in these patients.
Original languageEnglish
Pages (from-to)8-12
Number of pages5
JournalSeminars in Vascular Surgery
Volume34
DOIs
Publication statusPublished - 2021

Keywords

  • Anticoagulants
  • COVID-19
  • Humans
  • Ischemia
  • Lower Extremity
  • Mixing efficiency
  • Rayleigh-Taylor instability
  • Stratification
  • Thrombectomy
  • Thrombosis

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