Management of acute limb ischemia in post-covid recovery patients

Background: The transmission of the coronavirus disease (COVID-19) pandemic resulted in new challenges across all medical specialities. A hypercoagulable state is being observed in many patients with SARS-CoV-2 and is a predictor of a worse prognosis. Acute limb ischemia (ALI) is a limb and life-threatening condition with high morbidity and mortality. It is a relatively rare manifestation of the spectrum of COVID-19 related coagulopathy. Methods: A single centre, prospective, interventional study was performed from JUNE 2020 to JUNE 2021 in post-COVID recovery patients who developed ALI using endovascular therapy for revascularisation. Data collected included demographics, anatomical location of the arterial occlusion, treatments, and outcomes. Results: Over the 13 months, a total of 38 patients participated in the study. The mean age is 64.45 years, ranging from 16-75 years. 25 (65.78%) are men. 30 (78.94%) participants had lower limb involvement, and 8 (21.06%) had upper limb involvement. Pain and pulselessness were present in all the patients. However, only four patients (10.52%) presented with paresis. Tibial arteries (most commonly) were affected in 24 (63.15%) patients. Radial arteries were involved in only 5.26%. 55.26% of presentations were Rutherford stage IIb. We used a combination of transluminal balloon angioplasty, thromboaspiration, Catheter-directed thrombolysis and stenting. Revascularisation was achieved in 35 (92.1%). Two (5.26%) patients were amputated. One (2.36%) patient died. Conclusion: A thorough understanding of endovascular techniques, associated pharmacology, and perioperative care is paramount to endovascular management success in patients presenting with AIL.