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Ekim M, Ekim H, Akarsu GD. Diabetic peripheral arterial disease in COVID-19 pandemic. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2024; 29:35. [PMID: 39239073 PMCID: PMC11376723 DOI: 10.4103/jrms.jrms_509_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/05/2024] [Accepted: 01/31/2024] [Indexed: 09/07/2024]
Abstract
Both diabetes and peripheral arterial disease (PAD) have complex interactions with COVID-19. PAD is one of the most important underlying factors in the development of diabetic foot. The COVID-19 pandemic has also caused an increase in cardiovascular complications in those with chronic diseases, including diabetics, due to both the thrombophilic course of the viral disease and the lockdown measures applied for prevention. Since both COVID-19 and diabetes mellitus predispose to thrombosis, PAD is likely to have a more severe course in diabetic patients with COVID-19. The aim of our study is to discuss the complications, prophylaxis, and treatment of PAD, which is a serious complication of diabetes, during the pandemic period.
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Affiliation(s)
- Meral Ekim
- Department of Nutrition and Dietetics, Yozgat Bozok University Faculty of Health Sciences, Yozgat, Turkey
| | - Hasan Ekim
- Department of Cardiovascular Surgery, Yozgat Bozok University Faculty of Medicine, Yozgat, Turkey
| | - Gökhan Doğukan Akarsu
- Division of Molecular Medicine, Laboratory for Advanced Genomics, Ruder Boskovic Institute, Zagreb, Croatia
- Department of Pharmacy Services, Yozgat Bozok University School of Health Services, Yozgat, Turkey
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Martinez-Ortega JI, Perez Hernandez FDJ, Ortegon Blanco AE. Acro-Ischemia Associated With SARS-CoV-2: A Case Report. Cureus 2024; 16:e53798. [PMID: 38465147 PMCID: PMC10924074 DOI: 10.7759/cureus.53798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/12/2024] Open
Abstract
COVID-19 is known to cause various cutaneous lesions, including acro-ischemic lesions (AIL), which are associated with poor prognosis. Anticoagulant therapy has shown positive responses in AIL patients. However, in this case study, we present a fatal AIL case despite anticoagulant therapy. We propose different treatment approaches based on the limited current data on acro-ischemia pathogenesis related to SARS-CoV-2. The clinical case involved a 59-year-old male with severe COVID-19 symptoms, including acrocyanosis and right hemiparesis. Despite receiving anticoagulant therapy, the patient's condition worsened, leading to necrosis in the left foot. The discussion focuses on the high-risk nature of AIL, the potential link between angiotensin-converting enzyme 2 (ACE2) receptors and vasculitis or thromboembolic manifestations, and the role of immune clots in AIL pathogenesis. Behçet syndrome is referenced as a model of inflammation-induced thrombosis, guiding the suggestion for immunosuppressant-based treatment in addition to anticoagulants. Additionally, three substances, N-acetyl cysteine, sulodexide, and hydroxychloroquine, are proposed.
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Affiliation(s)
| | | | - Angel Enrique Ortegon Blanco
- Department of Internal Medicine, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Clínica Hospital B, Chetumal, MEX
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Fuchsberger S, Bloch-Infanger C, Mang G. [Livid Fingers after Respiratory Infection]. PRAXIS 2022; 111:947-950. [PMID: 36475364 DOI: 10.1024/1661-8157/a003941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Livid Fingers after Respiratory Infection Abstract. A 53-year-old patient fell ill with SARS-CoV-2. She suffered from cough, headache and slight exertional dyspnoea. She was hospitalized for a short time as the dyspnoea increased. Two weeks after the first respiratory symptoms, the patient developed painful livid discoloration of the left terminal phalanges I-III. An occlusion of the arteria princeps pollicis and the arteria digitalis communis/propria of the left fingers II and III could be documented in the angiography. In addition to short-term lysis therapy with alteplase, the patient was therapeutically anticoagulated and received aspirin. An ilomedin (iloprost) therapy was carried out.
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Affiliation(s)
| | | | - Georg Mang
- Innere Medizin Kantonsspital Uri, Schweiz
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Abstract
Thrombosis due to hypercoagulable state is an important cause of morbidity and mortality in coronavirus disease 2019 (COVID-19).
Increased D-dimer levels are an important marker of the presence and risk of thrombosis. In this report, we present that a 59-yearold
male patient developed thrombosis in the distal radial arteries despite normal D-dimer level. The patient was treated with
enoxaparin, iloprost infusion, and cilostazol. This case should lead us to be very careful that people diagnosed with COVID-19 with
normal D-dimer levels may also have thrombosis.
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Fluss G, Cranwell V, Rao A, Lee JS, Elshafey R, Wallack M, Finlay D. Covid-19 Delta variant resulting in multi system thromboembolic disease. ANNALS OF VASCULAR SURGERY - BRIEF REPORTS AND INNOVATIONS 2022; 2:100101. [PMID: 35784811 PMCID: PMC9222409 DOI: 10.1016/j.avsurg.2022.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 12/02/2022]
Abstract
Infection with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2/Covid-19) has been correlated with micro and macrovascular thrombosis. Reports have discussed localized thrombosis leading to ischemia, we report a case of diffuse systemic thromboembolism resulting in limb ischemia and organ damage from Covid-19 despite prompt anticoagulation. A 60-year-old unvaccinated male with a history of asthma, diabetes mellitus and coronary artery disease, presented with shortness of breath and right lower extremity pain. The patient was found to be Covid-19 Delta variant positive. CTA and transthoracic echocardiogram showed diffuse thromboembolic disease affecting the left ventricle, right kidney and bilateral lower extremities.
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Jain A, Reddy A, Murugesan R, Dutta S, Kumbhar U, Savlania A, Vaka SK. Outcomes of Patients With Acute Limb Ischemia in Patients With COVID-19: A Systemic Review and Meta-Analysis. Cureus 2022; 14:e27370. [PMID: 36046311 PMCID: PMC9418627 DOI: 10.7759/cureus.27370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/05/2022] Open
Abstract
A systemic review and meta-analysis of perioperative outcomes of acute limb ischemia (ALI) in patients with and without coronavirus disease-2019 (COVID-19) to determine the outcomes of ALI and compare the outcomes in patients with and without COVID-19 infection. A literature search of the Medline, Science Direct and Cochrane Library was performed from inception to July 15, 2021. Studies involving ALI in patients with COVID-19 were searched through three electronic databases. The endpoints include limb salvage, re-thrombosis, and mortality, and these outcomes were compared between patients with and without COVID-19 infection and type of management. The primary outcome was early limb salvage (till the patient was discharged from the hospital). The other outcomes assessed were re-thrombosis and mortality. These outcomes were compared between patients with and without COVID-19 infection and the type of management. Pooled estimates were presented as odds ratios (ORs) using a random or fixed effect model based on the results of the chi-square test and calculation of I2. Comparing the ALI outcomes in patients with and without COVID-19 infection, there was no significant difference in limb salvage rate (OR=0.26, 95% CI:0.02-3.09), but there was a significantly higher re-thrombosis (OR=2.65, 95% CI:1.34-5.23) and mortality rate (OR=4.71, 95% CI:1.11-19.99) in patients with COVID-19 infection. On comparing outcomes based on management, intervention group, and anticoagulant alone group, no significant difference was noted concerning limb salvage (OR=1.40, 95% CI:0.27-7.13) and mortality rates (OR=0.2, 95% CI:0.04-1.07). This meta-analysis demonstrates a higher re-thrombosis and mortality in ALI patients with COVID-19 infection when compared to patients without COVID-19 but with similar limb salvage.
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Affiliation(s)
- Ankit Jain
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Abhinaya Reddy
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Rajeswari Murugesan
- Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Souradeep Dutta
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Uday Kumbhar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ajay Savlania
- Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, IND
| | - Sivaranjit K Vaka
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Ojha V, Mani A, Mukherjee A, Kumar S, Jagia P. Mesenteric ischemia in patients with COVID-19: an updated systematic review of abdominal CT findings in 75 patients. Abdom Radiol (NY) 2022; 47:1565-1602. [PMID: 34761305 PMCID: PMC8580173 DOI: 10.1007/s00261-021-03337-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/22/2021] [Accepted: 10/26/2021] [Indexed: 12/12/2022]
Abstract
Background Acute mesenteric ischemia (AMI) is a less common but devastating complication of COVID-19 disease. The aim of this systematic review was to assess the most common CT imaging features of AMI in COVID-19 and also provide an updated review of the literature on symptoms, treatment, histopathological and operative findings, and follow-up of these patients. Methods A systematic literature search of four databases: Pubmed, EMBASE, WHO database, and Google Scholar, was performed to identify all the articles which described abdominal CT imaging findings of AMI in COVID-19. Results A total of 47 studies comprising 75 patients were included in the final review. Small bowel ischemia (46.67%) was the most prevalent abdominal CT finding, followed by ischemic colitis (37.3%). Non-occlusive mesenteric ischemia (NOMI; 67.9%) indicating microvascular involvement was the most common pattern of bowel involvement. Bowel wall thickening/edema (50.9%) was more common than bowel hypoperfusion (20.7%). While ileum and colon both were equally involved bowel segments (32.07% each), SMA (24.9%), SMV (14.3%), and the spleen (12.5%) were the most commonly involved artery, vein, and solid organ, respectively. 50% of the patients receiving conservative/medical management died, highlighting high mortality without surgery. Findings on laparotomy and histopathology corroborated strikingly with CT imaging findings. Conclusion In COVID-19 patients with AMI, small bowel ischemia is the most prevalent imaging diagnosis and NOMI is the most common pattern of bowel involvement. Contrast-enhanced CT is a powerful decision-making tool for prompt diagnosis of AMI in COVID-19, thereby potentially improving time to treat as well as clinical outcomes.
Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00261-021-03337-9.
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Affiliation(s)
- Vineeta Ojha
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Avinash Mani
- Department of Cardiology, Sri Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Aprateem Mukherjee
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India.
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FERNANDES CARLOSHENRIQUE, SABONGI RODRIGOGUERRA, SANTOS JOÃOBAPTISTAGOMESDOS. COVID-19 AND UPPER LIMB ANOMALIES IN NEWBORNS: A REASON FOR CONCERN? ACTA ORTOPEDICA BRASILEIRA 2022; 30:e252308. [PMID: 35431629 PMCID: PMC8979363 DOI: 10.1590/1413-785220223001e252308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022]
Abstract
The relationship between viral infection in pregnancy and congenital anomalies is reported in the medical literature. The risks for the SARS-CoV-2 virus interfering with implantation, growth, and fetal development are not yet known. Many drugs with potential teratogenic risk are being used for treatment. The studies with the vaccine excluded pregnant women from clinical trials, currently preventing high-quality evidence. We present a review of the most common anomalies in the upper extremities caused by congenital viral infection and the risks of anti-COVID-19 therapy and vaccine during pregnancy. We aim to alert orthopedic and hand surgeons to the possibility of these conditions in the future. Level of evidence V; Narrative review.
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Galyfos G, Sianou A, Frountzas M, Vasilios K, Vouros D, Theodoropoulos C, Michalopoulou V, Sigala F, Filis K. Acute limb ischemia among patients with COVID-19 infection. J Vasc Surg 2022; 75:326-342. [PMID: 34390791 PMCID: PMC8358086 DOI: 10.1016/j.jvs.2021.07.222] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/27/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE/BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with thrombotic complications such as deep vein thrombosis or stroke. Recently, numerous cases of acute limb ischemia (ALI) have been reported although pooled data are lacking. METHODS We systematically searched PubMed, Embase, Scopus, and the Cochrane Library for studies published online up to January 2021 that reported cases with SARS-CoV-2 infection and ALI. Eligible studies should have reported early outcomes including mortality. Primary endpoints included also pooled amputation, clinical improvement, and reoperation rates. RESULTS In total, 34 studies (19 case reports and 15 case series/cohort studies) including a total of 540 patients (199 patients were eligible for analysis) were evaluated. All studies were published in 2020. Mean age of patients was 61.6 years (range, 39-84 years; data from 32 studies) and 78.4% of patients were of male gender (data from 32 studies). There was a low incidence of comorbidities: arterial hypertension, 49% (29 studies); diabetes mellitus, 29.6% (29 studies); dyslipidemia, 20.5% (27 studies); chronic obstructive pulmonary disease, 8.5% (26 studies); coronary disease, 8.3% (26 studies); and chronic renal disease, 7.6% (28 studies). Medical treatment was selected as first-line treatment for 41.8% of cases. Pooled mortality rate among 34 studies reached 31.4% (95% confidence interval [CI], 25.4%%-37.7%). Pooled amputation rate among 34 studies reached 23.2% (95% CI, 17.3%-29.7%). Pooled clinical improvement rate among 28 studies reached 66.6% (95% CI, 55.4%%-76.9%). Pooled reoperation rate among 29 studies reached 10.5% (95% CI, 5.7%%-16.7%). Medical treatment was associated with a higher death risk compared with any intervention (odds ratio, 4.04; 95% CI, 1.075-15.197; P = .045) although amputation risk was not different between the two strategies (odds ratio, 0.977; 95% CI, 0.070-13.600; P = .986) (data from 31 studies). CONCLUSIONS SARS-CoV-2 infection is associated with a high risk for thrombotic complications, including ALI. COVID-associated ALI presents in patients with a low incidence of comorbidities, and it is associated with a high mortality and amputation risk. Conservative treatment seems to have a higher mortality risk compared with any intervention, although amputation risk is similar.
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Affiliation(s)
- George Galyfos
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece.
| | - Argiri Sianou
- Department of Microbiology, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Maximos Frountzas
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Kotsarinis Vasilios
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Dimitrios Vouros
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Charis Theodoropoulos
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Victoria Michalopoulou
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Frangiska Sigala
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
| | - Konstantinos Filis
- Vascular Surgery Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Hippocration Hospital, Athens, Greece
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Kumar S, Kumar A, Sinha R, Mahto M. Endovascular thrombectomy for critical lower limb ischaemia in a patient with COVID-19. BMJ Case Rep 2021; 14:14/11/e244941. [PMID: 34785513 PMCID: PMC8596029 DOI: 10.1136/bcr-2021-244941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Hypercoagulable and proinflammatory states induced by the novel coronavirus (SARS-CoV-2) lead to thrombotic and embolic events. In this case report, the authors describe how they successfully managed acute critical limb ischaemia in a patient of COVID-19 illness with severe pulmonary disease and high thrombus burden in the infrapopliteal arteries.
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Affiliation(s)
- Subhash Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences Patna, Patna, Bihar, India
| | - Anup Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences Patna, Patna, Bihar, India
| | - Ruchi Sinha
- Department of Pathology & Lab Medicine, All India Institute of Medical Sciences Patna, Patna, Bihar, India
| | - Mala Mahto
- Department of Biochemistry, All India Institute of Medical Sciences Patna, Patna, Bihar, India
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Abstract
The article highlights the pathogenesis, clinical manifestations of lesions of the central and peripheral nervous system that have arisen or persist in patients in the postcoid period (Long-COVID-19). Their correct assessment, the use of effective methods of complex treatment, targeted neurorehabilitation contribute to the reversibility of functional disorders, prevention, reduction of disability, improvement of quality of life indicators, prevention of the progression of cognitive, emotional, behavioral disorders initiated by SARS-CoV-2.
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Aziz F, Behrendt CA, Sullivan K, Beck AW, Beiles CB, Boyle JR, Mani K, Benson RA, Wohlauer MV, Khashram M, Jorgensen JE, Lemmon GW. The impact of COVID-19 pandemic on vascular registries and clinical trials. Semin Vasc Surg 2021; 34:28-36. [PMID: 34144744 PMCID: PMC8137351 DOI: 10.1053/j.semvascsurg.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023]
Abstract
Quality improvement programs and clinical trial research experienced disruption due to the coronavirus disease 2019 (COVID-19) pandemic. Vascular registries showed an immediate impact with significant declines in second-quarter vascular procedure volumes witnessed across Europe and the United States. To better understand the magnitude and impact of the pandemic, organizations and study groups sent grass roots surveys to vascular specialists for needs assessment. Several vascular registries responded quickly by insertion of COVID-19 variables into their data collection forms. More than 80% of clinical trials have been reported delayed or not started due to factors that included loss of enrollment from patient concerns or mandated institutional shutdowns, weighing the risk of trial participation on patient safety. Preliminary data of patients undergoing vascular surgery with active COVID-19 infection show inferior outcomes (morbidity) and increased mortality. Disease-specific vascular surgery study collaboratives about COVID-19 were created for the desire to study the disease in a more focused manner than possible through registry outcomes. This review describes the pandemic effect on multiple VASCUNET registries including Germany (GermanVasc), Sweden (SwedVasc), United Kingdom (UK National Vascular Registry), Australia and New Zealand (bi-national Australasian Vascular Audit), as well as the United States (Society for Vascular Surgery Vascular Quality Initiative). We will highlight the continued collaboration of VASCUNET with the Vascular Quality Initiative in the International Consortium of Vascular Registries as part of the Medical Device Epidemiology Network coordinated registry network. Vascular registries must remain flexible and responsive to new and future real-world problems affecting vascular patients.
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Affiliation(s)
- Faisal Aziz
- Integrated Vascular Surgery Program, Penn State Health Heart and Vascular Institute, Hershey, PA
| | | | | | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - C Barry Beiles
- Australian and New Zealand Society for Vascular Surgery, Australasian Vascular Audit, Melbourne, Victoria, Australia
| | - Jon R Boyle
- University of Cambridge, Cambridge, Cambridgeshire, UK; Vascular Society of Great Britain and Ireland, Staffordshire, UK
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ruth A Benson
- University Hospital Coventry and Warwickshire, West Midlands, UK
| | - Max V Wohlauer
- Vascular Surgery, University of Colorado, Denver, CO; Vascular Surgery COVID-19 Collaborative
| | - Manar Khashram
- Department of Surgery, University of Auckland, Auckland, NZ
| | - Jens Eldrup Jorgensen
- Tufts University School of Medicine, Boston, MA; Patient Safety Organization, Society for Vascular Surgery, Rosemont, IL
| | - Gary W Lemmon
- Patient Safety Organization, Society for Vascular Surgery, Rosemont, IL; Indiana University, 1801 N Senate Boulevard, D-3500, Indianapolis, IN 46202.
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Borrelli MP, Buora A, Scrivere P, Sponza M, Frigatti P. Arterial Thrombotic Sequalae After Covid-19: Mind the Gap. Ann Vasc Surg 2021; 75:128-135. [PMID: 33940162 PMCID: PMC8087612 DOI: 10.1016/j.avsg.2021.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 01/19/2023]
Abstract
Investigations have shown that infection from the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is responsible also for initiating severe inflammatory responses that can lead macrovascular and microvascular thrombosis. Several studies have already described acute limb ischemia and peripheral arterial disease in critically ill patients with Coronavirus disease 2019 (Covid-19), as well as coronary artery disease and ischemic stroke as a manifestation usually associated with respiratory distress. However, what still remains unclear is how long inflammation and thrombotic derangements can last after recovery from the symptoms of Covid-19. Hence, in this article we report 3 cases of arterial thrombotic sequalae after this viral infection. To the best of our knowledge, this is the first cases’ series that had described different delayed vascular arterial complications, which occurred after the index infection, with a negative nasopharyngeal swab and Covid-19 systemic symptoms resumption. A better understanding of the coagulopathy in Covid-19 could have an essential role to guide prevention and treatment of arterial thromboembolic events, both during and after the viral infection. Further investigations are required to confirm these data and to estabilish the type, dose and duration of anticoagulant/antiplatelet therapy not just during but also after Covid-19 infection.
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Affiliation(s)
- Maria Pia Borrelli
- Unit of Vascular and Endovascular Surgery, General Surgery Department, University Hospital of Udine, Udine, Italy.
| | - Adelaide Buora
- Unit of Vascular and Endovascular Surgery, General Surgery Department, University Hospital of Udine, Udine, Italy
| | - Paola Scrivere
- Unit of Vascular and Endovascular Surgery, General Surgery Department, University Hospital of Udine, Udine, Italy
| | - Massimo Sponza
- Unit of Interventional Radiology, Diagnostic Imaging Department, University Hospital of Udine, Udine, Italy
| | - Paolo Frigatti
- Unit of Vascular and Endovascular Surgery, General Surgery Department, University Hospital of Udine, Udine, Italy
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El Rhalete A, Rhazi I, Bensaid A, Zaid I, Bkiyer H, Ismaili N, Elouafi N, Housni B. Cardiovascular injuries during COVID-19 infection: A PROCESS-compliant case series from the Eastern Morocco. Ann Med Surg (Lond) 2021; 65:102309. [PMID: 33898022 PMCID: PMC8053362 DOI: 10.1016/j.amsu.2021.102309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 01/10/2023] Open
Abstract
Background To date, more than 105,805,951 cases of COVID-19 have been diagnosed including 2,312,278 deaths. Many patients have cardiovascular risk-factors and/or co-morbidities and a lot of them developed de novo heart conditions during the active or the post-infectious phase of the infection. A number of studies tried to demonstrate an association between poor prognostic outcomes and cardiovascular comorbidities and related damages, but the quality of current evidence is still weak. Patients and methods The aim of this single-center report is to describe the prevalence of cardiac injuries among our COVID-19 patients, to explore their association with survival outcomes and to demonstrate the medical care provided in our real-world setting. Our study included 610 COVID-19 patients admitted to the intensive care unit of our university hospital of whom13.77% (n = 84) presented cardiovascular injuries and which we included in this case series. Results The average age of our patients was 65 years (27–90). 60 were men (71.42%) while 24 were women (28.55%). Their average BMI was 29.7 kg/m2. Among them, 50 had a pulmonary embolism (59.52%), 12 patients had a myocardial infarction (14.28%), 10 presented pericarditis (11.9%) and 3 developed myocarditis (3.57%). There were 6 cases of ischemia (7.14%), 2 cases of stroke (2.38%), and 1 case of decompensated heart failure (1.19%). Among our patients, 46.42% had diabetes, 32.14% had a high blood pressure, 13.09% had a chronic renal failure and 14.28% had a history of ischemic heart disease. 14 patients (16.66%) had an elevated troponin with higher levels than 1000 ng/mL. The D-dimer value was high in almost all patients (80.95%). Lung damage from COVID-19 was extensive in 27.38%, severe in 32.14%, and critical in 40.47% of enrolled cases. CT chest angiography, ECG, and cardiac ultrasound were performed to the paraclinical confirmatory exploration of cardiac damages of these patients. Medical care was based on isolation, azithromycin, vitamin C, zinc, vitamin D, salicylic acid, dexamethasone followed with methylprednisolone, and anticoagulation for all hospitalized patients. Tocilizumab was indicated for 17 patients with hyperferritinemia (20.23% of patients). The initial respiratory care of our patients required oxygen therapy using nasal cannula (7.14%) high concentration masks (33.33%), high flow nasal cannula treatment (11.9%), non-invasive ventilation (NIV) (5.95%), and mechanical ventilation (41.66%). Thrombolysis was performed in three subjects with myocardial infarction and 2 underwent angioplasty with placement of an active stent at the proximal interventricular anterior artery, which all were successful. Three massive pulmonary embolisms died despite adequate treatment. Colchicine and salicylic acid were administered for pericarditis cases. Thromboprophylaxis was indicated for all patients and was reinforced if a venous thrombotic episode was confirmed. Patients with limb ischemia underwent surgical treatment. Among the 84 patients included in our cohort, 34 (40.47%) died in intensive care unit and 50 (59.52%) had a favorable evolution. Conclusion Cardiovascular involvement during COVID-19 should not be neglected and are associated with severe outcomes. Several studies have demonstrated an association between poor prognostic outcomes and cardiovascular comorbidities in COVID-19. The cardiovascular events in our case series confirmed these findings. Cardiovascular involvement during COVID-19 should not be neglected as it is associated with severe outcomes.
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Affiliation(s)
- Abdelilah El Rhalete
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Inas Rhazi
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Amine Bensaid
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Ikram Zaid
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Houssam Bkiyer
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
| | - Nabila Ismaili
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Nouha Elouafi
- Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital, Oujda, Morocco
| | - Brahim Housni
- Department of Intensive Care Unit, Mohammed VI University Hospital, Oujda, Morocco.,Faculty of Medicine and Pharmacy, Mohammed 1st University, Oujda, Morocco
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Aasen M, Blecha M. Percutaneous Revascularization for COVID-19 Induced Spontaneous Arterial Thrombosis. Vasc Endovascular Surg 2021; 55:781-786. [PMID: 33845697 DOI: 10.1177/15385744211010445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The optimal management strategy of acute limb ischemia in non-ventilated patients with COVID-19 is uncertain. We propose that non-ventilated patients who develop COVID-19 related spontaneous arterial thrombosis with associated limb threat may be best suited with percutnaeous revascularization to achieve limb salvage. Herein we describe 5 cases of patients who had severely threatened limbs with complete thrombosis of all 3 tibial arteries who were treated with percutaneous revascularization. All 5 patients were felt to be facing inevitable amputation without revascularization should they survive their COVID hospitalization. We were able to achieve limb salvage in all 5 patients selected for therapy, although 2 ultimately succumbed to respiratory failure.
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Affiliation(s)
- Margaret Aasen
- 12248Stritch School of Medicine, Loyola University Chicago, IL, USA
| | - Matthew Blecha
- Division of Vascular Surgery and Endovascular Therapy, Loyola University Chicago, IL, USA
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17
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Touzani S, Haddari F, Elbouazzaoui A, Houari N, Boukatta B, Kanjaa N. Acute Limb Ischemia in Critically ill COVID-19 Patients: a Case Series and Literature Review. JOURNAL OF MEDICAL AND SURGICAL RESEARCH 2021. [DOI: 10.46327/msrjg.1.000000000000191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The vascular burden increased by COVID-19 infection and including acute limb ischemia (ALI) quickly emerged as a major medical challenge with devastating consequences such as limb loss, multiorgan dysfunction and death. We report a case series of COVID-19 infection associated with ALI to raise awareness and knowledge towards this life-threatening association. Methods: COVIDS-19 patients with acute limb ischemia (ALI) managed in a Moroccan 14 beds COVID-19 ICU between March 2020 and January 2021, were reviewed. Data collected included demographics, clinical presentation, treatments and outcomes. Results: Over the 10-month period, our ICU cared for 407 hospitalized patients with confirmed COVID-19. A total of 6 COVID-19 patients with ALI were identified. The mean age was 61 years (52 - 70) and 5 were men. The most common preexisting condition was diabetes (50%). The mean CRP level was 219 mg/L. Five patients had thrombus in multiple locations. No concomitant deep vein thrombosis was identified. Four patients presented with signs of acute No arterial ischemia with or without respiratory symptoms and were subsequently diagnosed with COVID-19. The remaining two patients developed ischemia during hospitalization. Mean SOFA score was 5 (2 -9). Respiratory support, corticosteroids and heparin therapies were used in all patients. Intubation and vasopressors were required in four patients. Revascularization was performed in five patients and reintervention was necessary in three cases. Four patients died in the ICU while two were successfully discharged. Conclusion: ALI in COVID-19 patients is a challenging life-threatening vascular emergency that requires appropriate multidisciplinary management (intensivists, anesthesiologists, vascular surgeons and interventionists, radiologists, haematologists…) and further studies focused on anticoagulation.
Keywords: Acute Limb ischemia, Coagulopathy, COVID-19, SARS-CoV-2, Thrombosis
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