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COVID-19 Associated Acute Limb Ischemia
Based on several case series, patients with COVID-19-associated acute limb ischemia (from arterial thrombosis) were generally > 60 years old, overweight, and had other chronic conditions like hypertension, peripheral arterial disease, and diabetes—just like many wound care patients!
These patients present with mild vascular skin lesions that appear as small areas of discoloration (purpuric or petechial), as well as severe manifestations such as diffuse cyanosis and gangrene. Major amputation (eg, below-knee amputation, above-knee amputation) is required in 7%–35% of patients with COVID-19 as a result of peripheral thrombotic or embolic events. Timely recognition of skin discoloration and referral to vascular specialists is needed to optimize outcomes, and early patient counselling is needed.
- Bellosta R, Luzzani L, Natalini G, et al. Acute limb ischemia in patients with COVID-19 pneumonia. J Vasc Surg. 2020;72(6):1864-1872. doi:10.1016/j.jvs.2020.04.483
- Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in Hospitalized Patients With COVID-19 in a New York City Health System. JAMA. 2020;324(8):799-801. doi:10.1001/jama.2020.13372
- Etkin Y, Conway AM, Silpe J, et al. Acute Arterial Thromboembolism in Patients with COVID-19 in the New York City Area. Ann Vasc Surg. 2021;70:290-294. doi:10.1016/j.avsg.2020.08.085
- Hanff TC, Mohareb AM, Giri J, Cohen JB, Chirinos JA. Thrombosis in COVID-19. Am J Hematol. 2020;95(12):1578-1589. doi:10.1002/ajh.25982
- Indes JE, Koleilat I, Hatch AN, et al. Early experience with arterial thromboembolic complications in patients with COVID-19. J Vasc Surg. 2021;73(2):381-389.e1. doi:10.1016/j.jvs.2020.07.089
- Ilonzo N, Rao A, Safir S, et al. Acute thrombotic manifestations of coronavirus disease 2019 infection: Experience at a large New York City health care system [published online ahead of print, 2020 Sep 1]. J Vasc Surg. 2020;S0741-5214(20)31922-4. doi:10.1016/j.jvs.2020.08.038