American Journal of Medical Case Reports
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American Journal of Medical Case Reports. 2021, 9(6), 312-317
DOI: 10.12691/ajmcr-9-6-2
Open AccessLiterature Review

COVID-19 and Acute Limb Ischemia: A Systematic Review

Pramod Theetha Kariyanna1, Apoorva Jayarangaiah2, Anahat Kaur2, Amog Jayarangaiah3, Sushruth Das3, Ruchi Yadav4, Neema Jayachamarajapura Onkaramurthy5, Ashkan Tadayoni6, Moro O. Salifu6 and Isabel M. McFarlane6,

1Division of Interventional Cardiology, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Morningside/Beth Israel Hospitals, New York City, NY-10025, U.S.A.

2Division of Hematology and Oncology, Department of Internal Medicine, Albert Einstein College of medicine/ Jacobi Medical Center, Bronx, N.Y.-10461, U.S.A.

3Trinity School of Medicine, 925 Woodstock Road, Roswell, GA 30075, U.S.A.

4Department of Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, NY 11212, U.S.A.

5Department of Internal Medicine, NYC Health and Hospitals/Harlem Hospital Center, New York 10037, U.S.A

6Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, U.S.A.

Pub. Date: March 18, 2021

Cite this paper:
Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Anahat Kaur, Amog Jayarangaiah, Sushruth Das, Ruchi Yadav, Neema Jayachamarajapura Onkaramurthy, Ashkan Tadayoni, Moro O. Salifu and Isabel M. McFarlane. COVID-19 and Acute Limb Ischemia: A Systematic Review. American Journal of Medical Case Reports. 2021; 9(6):312-317. doi: 10.12691/ajmcr-9-6-2


The extraordinary prothrombotic manifestations of Coronavirus Disease-2019 (COVID-19), caused by severe acute respiratory syndrome CoV (SARS-CoV-2) virus, presenting as venous and arterial thrombosis have been reported in the literature. The incidence of arterial thrombosis is reported to be 4% in critically ill COVID-19 patients.. Arterial thrombosis in the setting of COVID-19 has been reported to occur in a multitude of organs leading to ischemic strokes, ST-segment elevation myocardial infarction, aortic thrombus and acute limb ischemia. Diffuse endothelial activation, along with aberrant immuno-thrombotic mechanisms have been implicated in the widespread thrombosis occurring in COVID-19 patients. We performed a literature review of 55 reported cases to delineate the clinical characteristics, management patterns and outcomes of patients with COVID-19 who developed complications of acute limb thrombosis and ischemia. Our systematic review revealed that acute limb ischemia had a male predominance, with either hypertension or diabetes mellitus as the most common underlying cardiovascular risk factors. Aortic thrombus was reported in 23.6% of the cases. The majority of the cases involved thrombosis in more than one limb, indicative of a diffuse thrombotic state. The most common artery affected was the left popliteal artery. Upper limb thrombosis occurred in 40% of the cases. Most of the cases (74.5%) were managed with urgent revascularization interventions and anticoagulation. Negative outcomes, including amputations (14.9%) and death (26.5%) occurred at a higher rate in this population, despite the use of standard management.

Coronavirus Disease-2019 (COVID-19) severe acute respiratory syndrome CoV (SARS-CoV-2) virus acute limb ischemia immune-thrombosis

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