Acute limb ischemia in patients with COVID-19 pneumonia

Abstract

Objectives

The aim of our study is to describe the incidence and characteristics, as well as clinical outcomes of patients presenting and treated for acute limb ischemia (ALI) in patients with novel coronavirus (COVID-19) infection during the 2020 coronavirus pandemic.

Methods

This is a single center, observational cohort study. Data of all patients tested positive with COVID-19 and presented with ALI vascular diseases requiring urgent operative treatment were collected in a prospectively maintained database. For this series, successful revascularization of the treated arterial segment was defined as the absence of early (<30 days) re-occlusion, or major amputation or death ≤24 hours. Primary outcomes were successful revascularization, early (≤30 days) and late survival (≥30 days), postoperative (≤ 30 days) complications, and limb salvage.

Results

We evaluated 20 patients with ALI who were positive for COVID-19. Considering the period January-to-March, the incidence rate of patients presenting with ALI in 2020 was significantly higher than 2019 [23/141 (16.3%) vs. 3/163 (1.8%), P < 0.001)]. There were 18 (90%) male and 2 female patients. Mean age was 75 years ± 9 (range, 62-95). All patients had already been diagnosed with COVID-19 pneumonia. Operative treatment was performed in 17 (85%) patients. Revascularization was successful in 12/17 (70.6%) patients.

Although successful revascularization was not significantly associated with the postoperative use of intravenous heparin (64.7% vs. 83.3%, P = 0.622), no patients receiving intravenous heparin required reintervention.

There were 8 (40%) in-hospital mortalities. Age was significantly higher in those who died (years, 81 ± 10 vs. 71 ± 5, P = 0.008). The use of continued postoperative systemic heparin infusion was significantly associated with survival (0% vs. 57.1%, P = 0.042).

Conclusions

In our preliminary experience, the incidence of ALI has significantly increased during COVID-19 pandemic in the Italian Lombardia region. Successful revascularization was lower than expected which we hypothesize is due to a virus-related hypercoagulable state. The use of prolonged systemic heparin may improve surgical treatment efficacy as well as improve limb salvage and overall mortality.