Percutaneous Revascularization for COVID-19 Induced Spontaneous Arterial Thrombosis

2021 ◽  
pp. 153857442110104
Author(s):  
Margaret Aasen ◽  
Matthew Blecha
Keyword(s):  
Limb Salvage ◽  
Arterial Thrombosis ◽  
Management Strategy ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Optimal Management ◽  
Tibial Arteries ◽  
Complete Thrombosis ◽  
Percutaneous Revascularization ◽  
Ventilated Patients

The optimal management strategy of acute limb ischemia in non-ventilated patients with COVID-19 is uncertain. We propose that non-ventilated patients who develop COVID-19 related spontaneous arterial thrombosis with associated limb threat may be best suited with percutnaeous revascularization to achieve limb salvage. Herein we describe 5 cases of patients who had severely threatened limbs with complete thrombosis of all 3 tibial arteries who were treated with percutaneous revascularization. All 5 patients were felt to be facing inevitable amputation without revascularization should they survive their COVID hospitalization. We were able to achieve limb salvage in all 5 patients selected for therapy, although 2 ultimately succumbed to respiratory failure.

scholarly journals Safety of transfer, type of procedure, and factors predictive of limb salvage in a modern series of acute limb ischemia

2019 ◽  
Vol 69 (4) ◽  
pp. 1174-1179 ◽  
Author(s):  
Jake Hemingway ◽  
Davidson Emanuels ◽  
Shahram Aarabi ◽  
Elina Quiroga ◽  
Nam Tran ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Limb Ischemia ◽  
Acute Limb Ischemia

scholarly journals FT17. Factors Predicting Limb Salvage in Acute Limb Ischemia Treated at a Tertiary Referral Center

2017 ◽  
Vol 65 (6) ◽  
pp. 22S-23S
Author(s):  
Shahram Aarabi ◽  
David Emanuels ◽  
Elina Quiroga ◽  
Nam Tran ◽  
Benjamin W. Starnes ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Tertiary Referral ◽  
Tertiary Referral Center ◽  
Referral Center

scholarly journals Therapeutic Angiogenesis for Severely Ischemic Limbs — from Bench to Bedside in Acute Vascular Care

2017 ◽  
Vol 3 (4) ◽  
pp. 160-171
Author(s):  
Theodora Benedek ◽  
István Kovács ◽  
Imre Benedek
Keyword(s):  
Surgical Treatment ◽  
Limb Salvage ◽  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Therapeutic Angiogenesis ◽  
Lower Limbs ◽  
Current Status ◽  
High Morbidity ◽  
Acute Limb Ischemia ◽  
Promising Alternative

Abstract Severe limb ischemia represents a critical condition, being associated with high morbidity and mortality rates. Patients with critical limb ischemia (CLI) require urgent initiation of interventional or surgical treatment, as restoration of the blood flow is the only way to ensure limb salvage in these critical cases. At the same time, in acute limb ischemia, a dramatic form of sudden arterial occlusion of the lower limbs, the integrity of the limb is also seriously threatened in the absence of urgent revascularization. From patients with CLI, 40% are “no option CLI”, meaning patients in whom, due to anatomical considerations or to the severity of the lesions, there is no possibility to perform interventional or surgical treatment or they have failed. Therapeutic angiogenesis has been proposed to serve as an effective and promising alternative therapy for patients with severe limb ischemia who do not have any other option for revascularization. This review aims to present the current status in therapeutic angiogenesis and the role of different approaches (gene or cell therapy, intra-arterial vs. intramuscular injections, different sources of cells) in increasing the rates of limb salvage in patients with severe ischemia of the lower limbs.

scholarly journals Endovascular Revascularization Strategies Using Catheter-Based Thrombectomy Versus Conventional Catheter-Directed Thrombolysis for Acute Limb Ischemia

2021 ◽  
Author(s):  
Maofeng Gong ◽  
Xu He ◽  
Boxiang Zhao ◽  
Jie Kong ◽  
Jianping Gu ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Clinical Success ◽  
Limb Ischemia ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Clinical Event ◽  
Comparable Efficacy ◽  
Acute Limb Ischemia ◽  
Technical Success Rate ◽  
Catheter Directed Thrombolysis

Abstract Background Acute limb ischemia (ALI) is an important clinical event threatening both life and the affected limbs, but the optimal treatment for ALI remains undefined. The aim of this study was to compare the safety and effectiveness of thrombectomy approaches via either catheter-based thrombectomy (CBT) or catheter-directed thrombolysis (CDT). Methods A total of 98 patients (mean age 69.7 years, 60 male) who underwent endovascular intervention for ALI from January 2015 to August 2018 were included. Of these, 57 were treated with primary CBT via a large-bore catheter, an AngioJet catheter or Rotarex catheter, and/or underwent low-dose CDT, and 41 were treated with primary CDT. The safety and effectiveness of CBT compared to conventional CDT and other various endovascular techniques were evaluated. Results More Rutherford IIb patients were treated with primary CBT (68.4%) than CDT (26.8%; P < .001). Patients who underwent primary CBT achieved a higher technical success rate than those who underwent primary CDT in a shorter procedure time (P < .001), whereas 42.1% of patients who underwent CBT did not need adjunctive CDT. The duration and dosage of adjunctive CDT in the CBT group were significantly decreased compared with those in the primary CDT group (both P < .001), and the CBT group achieved a shorter in-hospital length of stay (P < .001). Subgroup analysis revealed that patients treated with AngioJet and Rotarex catheters achieved slightly lower dosages, shorter CDT durations and shorter in-hospital stay lengths than those treated with large-bore catheters (P > .05). Clinical success was estimated to be achieved in 98.2% of patients who underwent CBT, which is similar to the 97.6% estimated in those who underwent primary CDT (P = 1.000), and this finding was similar among the CBT subgroups. Patients who underwent primary CBT had slightly fewer complications than those who underwent primary CDT (P = .059), especially minor complications (P = .036). The freedom from amputation at 6 and 12 months for CBT and CDT was assessed (93.0% vs 90.2% respectively, P = .625; 89.5% vs 82.5%, respectively, P = .34,). Comparable limb salvage was found for different techniques of large bore catheters, AngioJet catheters and Rotarex catheters. The Kaplan-Meier table analysis also showed similar limb salvage rates between groups. Conclusions Endovascular treatment of ALI with the use of catheter-based therapies is a safe and effective modality with similar safety and clinical outcome to conventional CDT alone, and this treatment modality overcomes the common shortcomings of CDT alone. Different CBT techniques have comparable efficacy but different adverse event profiles.

scholarly journals COVID-19 Complicated with Arterial Thrombosis Resulting Acute Limb Ischemia: A Case Report from Bangladesh

2020 ◽  
pp. S50-S56
Author(s):  
Md Reaz Uddin Chowdhury ◽  
Kazi Shanzida Akter ◽  
Sahedul Islam Bhuiyan ◽  
Bimal Chandra Das ◽  
Mohammad Moksedul Moula ◽  
...  
Keyword(s):  
Arterial Thrombosis ◽  
Virus Disease ◽  
Rare Complication ◽  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Rare Presentation ◽  
Need To Evaluate ◽  
Huge Impact ◽  
Few Data

COVID-19(Corona virus disease 2019), which starts from Wuhan, China on December, 2019 spread rapidly to different countries of the world including Bangladesh. It affects huge impact on health care system. It’s a new disease with multisystem involvement. Physicians are experiencing new presentation of different cases and rare complication including arterial thrombosis. Few data is available regarding arterial thrombosis in SARS-CoV-2 infected patients. We are currently fighting with a 60 year old lady suffering from COVID-19 pneumonia with other co-morbidities developed severe arterial occlusion of right leg despite of taking anti platelet for long time for another cause. Patient developed irreversible right lower limb ischemia not improving with continuous infusion of unfractionated heparin followed by severe pulmonary embolism. So further study and recommendations will need to evaluate the cases and treatment in COVID-19 Patients with rare presentation. Bangladesh Journal of Infectious Diseases, October 2020;7(suppl_2):S50-S56

scholarly journals Acute Limb Ischemia Due to Arterial Thrombosis Associated With Coronavirus Disease 2019

2020 ◽  
Vol 2 (6) ◽  
pp. e0140
Author(s):  
Krishnan Warrior ◽  
Paul A. Chung ◽  
Nida Ahmed ◽  
Michael C. Soult ◽  
Kevin P. Simpson
Keyword(s):  
Arterial Thrombosis ◽  
Limb Ischemia ◽  
Acute Limb Ischemia

Limb Salvage Does Not Predict Functional Limb Outcome after Revascularization for Traumatic Acute Limb Ischemia

2020 ◽  
Vol 66 ◽  
pp. 220-224
Author(s):  
Jason R. Hurd ◽  
David F. Emanuels ◽  
Shahram Aarabi ◽  
Mohini Dasari ◽  
Benjamin W. Starnes ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Functional Limb

Complex Endovascular Treatment for Critical Limb Ischemia in Poor Surgical Candidates: A Pilot Study

2002 ◽  
Vol 9 (5) ◽  
pp. 599-604 ◽  
Author(s):  
Bruce H. Gray ◽  
John R. Laird ◽  
Gary M. Ansel ◽  
John W. Shuck
Keyword(s):  
Endovascular Treatment ◽  
Limb Salvage ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Intention To Treat ◽  
Area Reduction ◽  
Tibial Arteries ◽  
Table Analysis ◽  
A Prospective Study

Purpose: To evaluate the effectiveness of complex endovascular treatment for limb salvage in patients with critical limb ischemia. Methods: In a prospective study, 23 patients (13 men; mean age 70 ± 11 years, range 44–87) with ischemic ulceration or gangrene of 25 lower limbs were enrolled at 4 sites to evaluate treatment with excimer laser recanalization followed by balloon angioplasty with optional stenting in the superficial femoral, popliteal, and/or tibial arteries. Results: Multiple lesions (mean 3.1, range 1–8) were treated in most cases. Reduction of stenosis/occlusion to <50% was achieved in 22 (88%) limbs. Individual cases of vessel perforation, inability to cross the lesion, and excessive residual stenosis accounted for the 3 failures. Over a 6-month period, 4 patients died of cardiac comorbidity and 1 was lost to follow-up. Adverse events included 4 minor and 2 below-knee amputations, 4 secondary angioplasties, and 4 femorodistal bypasses. The mean wound area reduction was 70% at 3 months, increasing to 89% at 6 months. According to life table analysis, the limb salvage rate was 90% with bypass and 69% without in the successfully treated patients (corresponding intention-to-treat rates were 79% and 61%). Conclusions: Complex endovascular treatment combining laser debulking and angioplasty/stenting offers an alternative for patients with critical limb ischemia who lack good surgical options.

scholarly journals An Observational Study on Patients with Acute Limb Ischemia and SARS-CoV-2 Infection: Early and Late Results in Limb Salvage Rate

2021 ◽  
Vol 10 (21) ◽  
pp. 5083
Author(s):  
Sorin Barac ◽  
Roxana Ramona Onofrei ◽  
Petru Vlad Neagoe ◽  
Alexandra Ioana Popescu ◽  
Stelian Pantea ◽  
...  
Keyword(s):  
Survival Rate ◽  
Observational Study ◽  
Limb Salvage ◽  
Open Surgery ◽  
Limb Ischemia ◽  
Late Results ◽  
Acute Limb Ischemia ◽  
Free Survival ◽  
Risk Of Death ◽  
Revascularization Procedures

An observational study on 22 patients presenting with acute limb ischemia and SARS-CoV-2 infection, and without any other embolic risk factors, was performed. All patients were classified according to Rutherford classification for acute limb ischemia. The primary goal of this study was to assess the risk of amputation in these patients after revascularization procedures. The secondary goal was to find the correlation between acute limb ischemia (ALI) severity, patient comorbidities, risk of death, and the association of SARS-CoV-2 infection. The patients were treated by open surgery (18 patients—81.81%) or by the means of endovascular techniques (four patients—18.18%). The amputation-free survival rate was 81.81% in hospital and 86.36% at 1-month follow-up. In this study, the presence of SARS-CoV-2 infection did not influence the amputation-free survival rate: it was only the risk factor for the arterial thrombosis and the trigger for the acute ischemic event. The application of the standard treatment—open surgery or endovascular revascularization—in patients with acute limb ischemia and SARS-CoV-2 infection represents the key to success for lower limb salvage.

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