Objective: Examine the occurrence and clinical outcomes of arterial thrombosis leading to limb- threatening ischemia in patients with coronavirus-2019 (COVID-19). Study design: Prospective, descriptive case series . Patients and
Methods: Forty-four patients with COVID-19 infection presenting with critical limb ischemia were managed between March 2020 and December 2020 . The patients were divided into three groups based on the mode of presentation : 1) those who had been admitted; 2) those presenting in the emergency department; and 3) those presenting to vascular clinics . Clinical evidence suggesting limb ischemia was evaluated with computerized tomographic angiogram . Vascular care was designed according to the need of individual patients, through anticoagulation, revascularization by thrombo-embolectomy, or bypass grafting and amputation .
Results: Ten major amputations and 4 deaths (all in patients admitted) occurred among the 44 patients (9.1 %). Most patients (32/44) were males, mean age was 55, and limb ischemia occurred among patients as young as 29 . The initial period of ischemia was often not appreciated by patients and physicians . Critical limb ischemia was often not correlated with the severity of COVD symptoms: of 17 patients who presented through the emergency room with limb-threatening ischemia, 10 (58.9 %) were asymptomatic for respiratory and general symptoms . Comorbidities were common among all 3 patient groups (26/44; 59 %). Anticoagulants did not consistently prevent thromboembolic events since all admitted patients were receiving low molecular weight heparin . The rate of revascularization was lower in this population than in the general population with similar limb ischemia . Conclusion: Acute limb ischemia in patients with COVID-19 is a vascular emergency that can result in limb loss and even death . The severity of respiratory infection and other symptoms of COVID often are not consistent with the severity and level of vascular involvement . Timely recognition and tailored intervention is needed to save limbs in this population.