Two Different Clinical Presentations of Acute Limb Ischemia Caused by Acute Thrombotic Events in COVID-19

An Alarming Sign: Acute Limb Ischemia in Patients With COVID-19

Acute limb ischemia (ALI) can occur as a late complication in patients recovering from COVID-19. Although typically seen during the acute phase, ALI may present weeks to months later, making diagnosis more challenging. Symptoms, including acute limb pain, pallor, coldness, and absent pulses, can be misattributed to other post-viral issues. COVID-19 induces a prothrombotic state that persists after recovery, with increased D-dimer, fibrinogen, and endothelial dysfunction contributing to thrombus formation. Early diagnosis through clinical assessment and imaging is crucial to prevent irreversible limb damage. Treatment involves anticoagulation, revascularization, and supportive care, tailored to the patient's condition. Vigilance for late-onset ALI in post-COVID-19 patients is essential to improve outcomes and prevent limb loss.

SARS-CoV-2 gamma variant and chronic arterial insufficiency due to late arterial thrombosis

The current evidence suggests a state of hypercoagulability as one of the sequelae of hyperinflammation. Thus, it is an important pathogenic mechanism that contributes to increase the mortality caused by COVID-19. The aim of the present study is to report chronic arterial insufficiency after post-thrombosis in the same arteries 32 days later, as a sequel after severe acute respiratory syndrome coronavirus 2 P.1. After the 2^nd day of discharge, she had a lot of pain in her left and limiting leg and was referred to the vascular service. The patient was evaluated by vascular surgery who underwent a clinical diagnosis of Rutherford II.A arterial thrombosis and underwent arteriography of the limb that revealed thrombosis of the anterior, posterior, and fibular arteries in the middle third and the plantar arch was not contrasted. She underwent emergency embolectomy with selective isolation of the tibial arteries, but with success after the procedure only for the posterior tibial artery. Anticoagulation was maintained and 100 mg aspirin was associated.