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Kazantsev AN, Zharova AS, Shmatov DV, Zakeryaev AB, Lider RY, Kazantseva EG, Bagdavadze GS, Korotkikh AV, Lutsenko VA, Sultanov RV, Lebedev OV, Sirotkin AA, Snopova EV, Palagin PD. The results of thrombectomy from the arteries of the lower extremities in patients infected with SARS-CoV-2 Omicron variant with different severity of respiratory failure. Vascular 2024; 32:811-819. [PMID: 36867526 PMCID: PMC9988629 DOI: 10.1177/17085381231160933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
GOAL Analysis of the results of thrombectomy from the arteries of the lower extremities in patients with COVID-19 against the background of different severity of respiratory failure. MATERIALS AND METHODS This retrospective, cohort, comparative study for the period from 05/01/2022 to 20/07/2022 included 305 patients with acute thrombosis of the arteries of the lower extremities against the background of the course of COVID-19 (SARS-CoV-2 Omicron variant). Depending on the type of oxygen support, 3 groups of patients were formed: group 1 (n = 168) - oxygen insufflation through nasal cannulas; group 2 (n = 92) - non-invasive lung ventilation; and group 3 (n = 45) - artificial lung ventilation. RESULTS Myocardial infarction and ischemic stroke were not detected in the total sample. The highest number of deaths (group 1: 5.3%, n = 9; group 2: 72.8%, n = 67; group 3: 100%, n = 45; p < 0.0001), rethrombosis (group 1 : 18.4%, n = 31; group 2: 69.5%, n = 64; group 3: 91.1%, n = 41; p < 0.0001), and limb amputations (group 1: 9.5%, n = 16; group 2: 56.5%, n = 52; group 3: 91.1%, n = 41; p < 0.0001) was recorded in group 3 (ventilated) patients. CONCLUSION In patients infected with COVID-19 and on artificial lung ventilation, a more aggressive course of the disease is noted, expressed in an increase in laboratory parameters (C-reactive protein, ferritin, interleukin-6, and D-dimer) of the degree of pneumonia (CT-4 in overwhelming number) and localization of thrombosis of the arteries of the lower extremities, mainly in the tibial arteries.
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Affiliation(s)
- Anton N Kazantsev
- Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russian Federation
| | - Alina S Zharova
- North-Western State Medical University named after I. I. Mechnikov, Saint Petersburg, Russian Federation
| | - Dmitriy V Shmatov
- Clinic of High Medical Technologies named after N. I. Pirogov St Petersburg State University, Saint Petersburg, Russian Federation
| | - Aslan B Zakeryaev
- Research Institute Regional Clinical Hospital No. 1 named. prof. S.V. Ochapovsky, Krasnodar, Russian Federation
| | - Roman Yu Lider
- Kemerovo State Medical University of the Ministry of Health of the Russian Federation, Kemerovo, Russian Federation
| | - Elizaveta G Kazantseva
- Kemerovo State Medical University of the Ministry of Health of the Russian Federation, Kemerovo, Russian Federation
| | - Goderzi S. Bagdavadze
- North-Western State Medical University named after I. I. Mechnikov, Saint Petersburg, Russian Federation
| | - Alexander V Korotkikh
- Clinic of Cardiac Surgery of the Amur State Medical Academy of the Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | - Victor A Lutsenko
- Kemerovo Regional Clinical Hospital named after S. V. Belyaeva, Kemerovo, Russian Federation
| | - Roman V Sultanov
- Kemerovo Regional Clinical Hospital named after S. V. Belyaeva, Kemerovo, Russian Federation
| | - Oleg V Lebedev
- Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russian Federation
| | - Alexey A Sirotkin
- Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russian Federation
| | - Elena V Snopova
- Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russian Federation
| | - Petr D Palagin
- Kostroma Regional Clinical Hospital named after E. I. Korolev, Kostroma, Russian Federation
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Indriani S, Amshar M, Nugraha RA, Siddiq T, Adiarto S. Acute Limb Ischemia in COVID-19: A Systematic Review. Int J Angiol 2023; 32:215-226. [PMID: 37927841 PMCID: PMC10624540 DOI: 10.1055/s-0043-1771250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Numerous studies have reported cases of acute limb ischemia (ALI) in coronavirus disease 2019 (COVID-19), along with a sharp increase of ALI incidence during the COVID-19 pandemic. The objective of this study was to analyze the clinical features, treatment strategies, and outcomes in COVID-19 patients who developed ALI. A systematic search was performed in PubMed, ScienceDirect, and Cochrane to identify relevant articles. Variables of interest included ALI location, ALI and COVID-19 severity, concomitant thrombosis, comorbidities/risk factors, coagulation and inflammatory parameters, therapy, outcome, and cause of death. Data extraction and pooling were conducted by two reviewers. Fifty-six articles with a total of 191 subjects were included in the analysis; 78.5% of the subjects were male; mean age was 64.2 years; 94.2% of cases were ALI de novo; 41.1% of the subjects had ALI stage IIB; 82.7% of ALI occurred in the lower limb. The popliteal artery was the most commonly affected artery (48.2% of subjects); 38.1% of the subjects had severe COVID-19; 11.1% had asymptomatic COVID-19, and 15.9% were post-COVID-19; 50.7% of the subjects had hypertension; 12.0% of the subjects had concomitant thrombosis; 98.1% of the subjects had elevated D-dimer, and 83.3% of the subjects had elevated C-reactive protein; 61.9% of the subjects underwent surgical thromboembolectomy, 21.3% underwent conservative treatment, and 8.1% underwent amputation initially. The overall mortality rate and limb amputation rate were 39.3 and 22.4%, respectively; 67.6% of deaths were due to respiratory failure. Our study supports that COVID-19 is associated with hypercoagulability that may trigger the development of ALI, and that ALI is a possible predictor of poor outcome in COVID-19 patients.
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Affiliation(s)
- Suci Indriani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Division of Vascular Medicine, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Mohamed Amshar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Raka Aldy Nugraha
- Department of General Medicine, Universitas Indonesia Hospital, Depok, West Java, Indonesia
| | - Taofan Siddiq
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Division of Vascular Medicine, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Suko Adiarto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Division of Vascular Medicine, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Ferraro JJ, Reynolds A, Edoigiawerie S, Seu MY, Horen SR, Aminzada A, Hamidian Jahromi A. Associations between SARS-CoV-2 infections and thrombotic complications necessitating surgical intervention: A systematic review. World J Methodol 2022; 12:476-487. [PMID: 36479312 PMCID: PMC9720352 DOI: 10.5662/wjm.v12.i6.476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/01/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several unique clinical features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19) infection, have been identified and characterized. One such feature, mostly among patients with severe COVID-19 infection, has become known as COVID-19-induced coagulopathy. Surgical patients with a history of or active COVID-19 infection bear a significantly higher risk for postoperative thrombotic complications. These patients may require surgical intervention to treat severe thrombotic complications. Few studies have been carried out to better characterize this association. The purpose of this study was to perform a systematic review and meta-analysis of the literature on COVID-19 infections that led to thrombotic complications necessitating surgical intervention. We hypothesized that patients with recent or active COVID-19 infection would have high rates of thromboembolic complications both arterial and venous in origin. AIM To perform a systematic review and meta-analysis of the literature on COVID-19 infections that led to thrombotic complications necessitating surgical intervention. METHODS The current systematic review implemented an algorithmic approach to review all the currently available English medical literature on surgical interventions necessitated by COVID-19 thrombotic complications using the preferred reporting items for systematic reviews and meta-analysis principles. A comprehensive search of the medical literature in the "PubMed", "Scopus", "Google Scholar" top 100 results, and archives of Plastic and Reconstructive Surgery was performed using the key words "COVID-19" AND "surgery" AND "thromboembolism" AND "complication". The search string was generated and the records which were not specific about surgical interventions or thrombotic complications due to COVID-19 infection were excluded. Titles and abstracts were screened by two authors and full-text articles were assessed for eligibility and inclusion. Finally, results were further refined to focus on articles that focused on surgical interventions that were necessitated by COVID-19 thrombotic complications. RESULTS The database search resulted in the final inclusion of 22 retrospective studies, after application of the inclusion/exclusion criteria. Of the included studies, 17 were single case reports, 3 were case series and 2 were cross sectional cohort studies. All studies were retrospective in nature. Twelve of the reported studies were conducted in the United States of America, with the remaining studies originating from Italy, Turkey, Pakistan, France, Serbia, and Germany. All cases reported in our study were laboratory confirmed SARS-CoV-2 positive. A total of 70 cases involving surgical intervention were isolated from the 22 studies included in this review. CONCLUSION There is paucity of data describing the relationship between COVID-19 infection and thrombotic complications necessitating the need for surgical intervention. Intestinal ischemia and acute limb ischemia are amongst the most common thrombotic events due to COVID-19 that required operative management. An overall postoperative mortality of 30% was found in those who underwent operative procedures for thrombotic complications, with most deaths occurring in those with bowel ischemia. Physicians should be aware that despite thromboprophylaxis, severe thrombotic complications can still occur in this patient population, however, surgical intervention results in relatively low mortality apart from cases of ischemic bowel resection.
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Affiliation(s)
- Jennifer J Ferraro
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Allie Reynolds
- Medical School, University of Chicago, Chicago, IL 60637, United States
| | | | - Michelle Y Seu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Sydney R Horen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
| | - Amir Aminzada
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL 60612, United States
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Brem FL, Tayef TAA, Rasras H, Mahi OE, Ouafi NE, Zakaria B. Concomitant renal and splenic infarctions in a COVID-19-patient with a catastrophic thrombotic syndrome. Radiol Case Rep 2022; 17:4030-4033. [PMID: 35999857 PMCID: PMC9389916 DOI: 10.1016/j.radcr.2022.06.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/12/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Since the outbreak of the COVID-19 pandemic, thrombotic events have been accurately described in patients infected by the SARS-CoV-2, especially venous thromboembolism. However, the mystery of arterial thrombosis is still unclear. Here, we report the case of a 59-year-old man with diabetes mellitus, admitted for COVID-19-pneumonia complicated by pulmonary embolism, a thrombus in the aortic isthmus, the descending thoracic aorta associated with splenic and left renal infarctions, and an acute right limb ischemia. The etiological assessment of this catastrophic thrombotic syndrome showed no evidence for preexisting inherited or acquired thrombophilia. Our case emphasizes the hypercoagulability state in COVID-19-patient leading to both arterial and venous thromboembolisms and the need to establish adequate strategies for the diagnosis and management of thrombo-embolisms to prevent these potentially fatal complications.
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Affiliation(s)
- Falmata Laouan Brem
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Corresponding author.
| | - Taha Abu Al Tayef
- Department of Vascular surgery, Mohamed VI University Hospital Center, Mohamed I University, Oujda, Morocco
| | - Hammam Rasras
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Omar El Mahi
- Department of Vascular surgery, Mohamed VI University Hospital Center, Mohamed I University, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Bazid Zakaria
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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Facciponte DN, Shaw P. Venous gangrene associated with COVID-19: Successful limb preservation strategies with optimal wound management. ANNALS OF VASCULAR SURGERY - BRIEF REPORTS AND INNOVATIONS 2022; 2:100095. [PMID: 35782340 PMCID: PMC9132686 DOI: 10.1016/j.avsurg.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/22/2022] [Accepted: 05/21/2022] [Indexed: 12/02/2022]
Abstract
During the COVID-19 pandemic, high rates of arterial and venous thromboembolic (VTE) events were noted in association with increased rates of major amputation. VTE appears to be a significant source of morbidity and mortality for this patient population and numerous methods have been described to achieve limb salvage. Nevertheless, best management remains unclear. We describe the case of a 60-year-old male with severe venous gangrene secondary to a non-occlusive mid-femoral and occlusive infrapopliteal deep venous thromboses associated with COVID-19 infection who ultimately underwent meticulous local wound care and transmetatarsal amputation, which allowed for maximal preservation of foot function and limb salvage.
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Lee KA, McBride RS, Narlawar R, Myers R, Antoniou GA. COVID Toes: Concurrent Lower Limb Arterial and Venous Thromboembolism in a Patient with COVID-19 Pneumonitis Presenting with Foot Ischaemia. Vasc Endovascular Surg 2021; 56:201-207. [PMID: 34592855 DOI: 10.1177/15385744211045600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We present a 74-year-old gentleman, who presented with foot ischaemia requiring bilateral amputation in the absence of radiological signs of occlusive peripheral arterial disease. He was found to have COVID-19 pneumonitis and concurrent arterial and venous thromboemboli despite no initial respiratory symptoms or signs, nor pre-existing risk factors for cardiovascular disease. Patients who present with foot ischaemia with or without respiratory symptoms or signs warrant a high index of suspicion for COVID-19 infection, particularly in those with no predisposing risk factors.
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Affiliation(s)
- Kathryn A Lee
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard S McBride
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ranjeet Narlawar
- Department of Radiology, The Royal Oldham Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Rebecca Myers
- Department of Radiology, The Royal Oldham Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Cardiovascular Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
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Attisani L, Pucci A, Luoni G, Luzzani L, Pegorer MA, Settembrini AM, Bissacco D, Wohlauer MV, Piffaretti G, Bellosta R. COVID-19 and acute limb ischemia: a systematic review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:542-547. [PMID: 34581552 DOI: 10.23736/s0021-9509.21.12017-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The main goal of this systematic review is to analyze the outcomes of acute limb ischemia (ALI) in patients suffering from the novel Coronavirus COVID-19 (Sars-Cov-2). EVIDENCE OF ACQUISITION A systematic review on MEDLINE and Embase was conducted up to May 15, 2021. All papers were sorted by abstract and full text by two independent authors. Systematic reviews, commentaries, and studies that did not distinguish status of COVID-19 infection were excluded from review. Patient demographics were recorded along with modality of treatment (endovascular and/or surgical). We analyzed 30-day outcomes, including mortality. Primary outcome was to evaluate clinical characteristic of ALI in patients affected by SARS-CoV-2 in term of location of ischemia, treatment options and 30-day outcomes. EVINDENCE SYNTHESIS We selected 36 articles with a total of 194 patients. The majority of patients were male (80%) with a median age of 60 years old. The treatment most used was thromboembolectomy (31% of all surgical interventions). A total of 32 patients (19%) were not submitted to revascularization due to critical status. The rate of technical success was low (68%) and mortality rate was high (35%). CONCLUSIONS This review confirms that Sars-Cov-2 is associated with a high risk of ALI. Further studies are needed to investigate the association and elucidate potential mechanisms, which may include a hypercoagulable state and hyperactivation of the immune response. Furthermore, management of ALI is not standardized and depends on patient's condition and extension of the thrombosed segment. ALI in COVID-19 patients is associated with high risk of failure of revascularization and perioperative mortality.
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Affiliation(s)
- Luca Attisani
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy -
| | - Alessandro Pucci
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giorgio Luoni
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Luca Luzzani
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Matteo A Pegorer
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Daniele Bissacco
- Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Max V Wohlauer
- Vascular Surgery, University of Colorado, Denver, CO, USA
| | | | - Raffaello Bellosta
- Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
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