Cardiovascular Surgery and Interventions 2024, Vol 11, Num 1 Page(s): 033-041
Our clinical experience in the management of COVID-19-related arterial thrombosis with acute limb ischemia

Anıl Özen1, Görkem Yiğit2, Alp Yıldırım1, Enis Burak Gül1, Metin Yılmaz3, Hakkı Zafer İşcan1

1Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Türkiye
2Department of Cardiovascular Surgery, Hitit University Erol Olçok Training and Research Hospital, Çorum, Türkiye
3Department of Cardiovascular Surgery, VM Medical Park Hospital, Ankara, Türkiye

Keywords: Acute limb ischemia, arterial thrombosis, COVID-19, embolectomy, thrombectomy
Objectives: This study aimed to report our clinical experience regarding the surgical management and perioperative treatment strategy of patients who presented to our clinic or were consulted with coronavirus disease 2019 (COVID-19)-associated acute limb ischemia (ALI).

Patients and methods: This retrospective observational single-center study was conducted with 40 patients (26 males, 14 females; mean age: 67.2±16.9 years; range, 26 to 92 years) between January 2020 and April 2021. All the patients diagnosed with mild to severe COVID-19 infection and presenting with ALI were managed and included in the study. The primary outcomes of the study were freedom from reocclusion, freedom from amputation, ALI-related early- to late-term survival, absence of early reocclusion (<30 days), forefoot ischemia, major amputation, and death <24 h after the operation. Secondary outcomes were postoperative complications.

Results: There was a significant relationship between early mortality and main femoral artery involvement (p=0.046). There was also a significant relationship between early mortality and the COVID-19 polymerase chain reaction test (p=0.013). Early mortality was observed in 100% of those who were intubated. Age and median fibrinogen levels of the group with late mortality were significantly higher than the group without late mortality (p=0.014 and p=0.021, respectively). The median fibrinogen levels of those with amputation were found to be significantly higher than those without amputation (p=0.048). Eleven (27.5%) patients included in the study died in the early period, whereas five (12.5%) died in the late period. Amputation was performed in three (7.5%) patients, and complications developed in seven (17.5%) patients.

Conclusion: According to the results of this study, surgical intervention for ALI might be difficult and more challenging than anticipated in patients with COVID-19 due to the hypercoagulable state. Cardiovascular surgeons and physicians should be aware of the benefits of extended pre- and postoperative anticoagulant administration.

DOI : 10.5606/e-cvsi.2024.1609