Acute Limb Ischemia in a Patient with COVID-19

Abstract

Patients with coronavirus disease (COVID-19) are at increased risk of thrombosis. A 70-year-old man with hypertension was hospitalized with fever, shortness of breath, and hypoxia. He had tested positive for COVID-19 9 days prior and exhibited a significantly elevated D-dimer level (28.2 µg/mL). One day after admission, new-onset acute right lower-extremity pain was reported. On examination, he had profound mild weakness in the right leg and absent pulses below the right femoral artery. Computed tomography angiography revealed a focal aortic thrombus at the level of the inferior mesenteric artery; a thrombus in the left anterior tibial vein; and acute occlusion of the right iliac artery, distal right profunda femoris artery, and popliteal artery. Electrocardiography revealed a normal sinus rhythm. Clinically, he had Trans-Atlantic Inter-Society Consensus II Stage IIb acute limb ischemia. The patient underwent emergent thrombectomy, and an acute thrombus was removed. Palpable pulses were restored in the right foot. The patient was maintained on therapeutic intravenous heparin and transitioned to direct oral anticoagulants. He has not experienced any recurrent ischemic limb events, but the aortic thrombus has not disappeared.