What Are The Vascular Ramifications Of COVID-19?

Check out the great work from friend and colleague William W. Li, MD and coworkers that was summarized in an elegant discussion in Health News from National Public Radio (NPR).¹ Scientists are now understanding that the COVID-19 virus warps the endothelium of blood vessels. Dr. Li, a vascular biologist, likened the endothelium to newly resurfaced ice on a skating rink. 

"When the virus damages the inside of the blood vessel and shreds the lining, that's like the ice after a hockey game," noted Dr. Li, a researcher and founder of the Angiogenesis Foundation. "You wind up with a situation that is really untenable for blood flow."¹

Dr. Li and his team recently published their findings of a study in the New England Journal of Medicine that compared the lungs of individuals who died from COVID-19 to those who died from influenza.² The interesting finding was that those with COVID-19 had nine times the amount of microthrombi in the blood vessels and significantly more endothelial injury in the lung vessels than patients who succumbed to influenza.² Even though COVID-19 is inherently a respiratory disease, it targets the vascularity, which is of special interest to podiatrists, who are deeply familiar with the risks of peripheral vascular disease, both from micro- and macrovascular standpoints.

Although the immediate effects are still under close study and perhaps the most important aspect of the research, there is still very little known about the long-term impact of COVID-19 on the body’s vasculature as a whole. 

Dr. Li says, "The virus enters your body and it leaves your body. You might or might not have gotten sick. But is that leaving behind a trashed vascular system?"¹

The most important thing for podiatrists to take from this discussion is the fact is that COVID-19 is as much a vascular disease as it is a pulmonary disease, perhaps even more so as these data suggest. Dr. Li and I have discussed this at great length since February 2020. Podiatrists and vascular surgeons are uniquely positioned to help diagnose complications and help keep folks moving through this pandemic.

Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA). 

Editor’s note: This blog originally appeared at: https://diabeticfootonline.com/2020/11/09/is-covid19-really-a-vascular-disease/ . It is adapted with permission from the author.

References

1. Stone W. Clots, strokes and rashes. Is COVID-19 a disease of the blood vessels? Health News from NPR. Available at: https://www.npr.org/sections/health-shots/2020/11/05/917317541/clots-strokes-and-rashes-is-covid-19-a-disease-of-the-blood-vessels . Published November 5, 2020. Accessed December 14, 2020. 

2. Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary vascular endothelialitis, thrombosis and angiogenesis in COVID-19. New Eng J Med. 2020;383(2):120-128.