A Case of Acute Upper Limb Ischemia with COVID-19 Pneumonia

Abstract

The patient was a 79-year-old man. He had a history of atrial fibrillation and was taking warfarin. In August 2021, he was hospitalized with COVID-19 pneumonia at the previous hospital and started treatment with remdesivir and dexamethasone. During treatment, symptoms of ischemia in the right upper limb appeared, and despite medical treatment, the symptoms gradually worsened. On the 8th hospital day, necrosis of the second finger appeared, and CT showed thrombotic occlusion of the right brachial artery. He was transferred to our hospital for advanced therapy. We performed emergent thrombectomy with the Fogaty catheter and the organized thrombus at the bifurcation of the brachial artery was removed. However, recurrence of ischemic symptoms was observed on the 6th postoperative day (POD), and thrombectomy was performed again. Although the blood flow temporarily improved, it recurred in the evening and the thrombus was removed again. The improvement in blood flow was poor and the muscles of the forearm were swollen. So we perform fasciotomy additionally. After that, the ischemic state continued, and amputation was considered, but POD13 after the first operation, the respiratory condition deteriorated rapidly and progressed to ARDS. He died the next day.