Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women

Introduction:Pregnancy is a physiologically hypercoagulable state and a coronavirus disease 2019 (COVID-19) infection adds to this burden by accentuating the coagulopathy. We report two cases of severe peri-partum COVID infection leading to extremity gangrene secondary to a pro-thrombotic coagulopathy. Case Report:A 37-year-old lady, day-2 postpartum, was brought with severe COVID infection & and respiratory failure. She developed progressive gangrene of the foot. A computed tomography (CT) angiogram confirmed the presence of thrombosis of the left external iliac & and common femoral artery. She was managed with catheter- directed thrombolysis and fasciotomy. The dry gangrene of the foot was managed with a Boyd’s amputation. At 1-year follow-up, she is ambulant with a healthy stump. Case Two: A 34-year-old lady, 36 weeks of gestation, presented with fulminant COVID infection with respiratory failure and pulmonary embolus. The lady developed gangrene of the B/L toes. A CT angiogram revealed thrombosis below the popliteal trifurcation in both limbs along with segmental pulmonary thrombo-embolism involving the right lung and multiple splenic infarcts. She succumbed to the overwhelming infection and sepsis. Discussion:The pathogenesis of coagulopathy in pregnant COVID patients is attributed to the hypercoagulable effect, which leads to thrombo-embolisms and limb ischemia following a cytokine storm syndrome in severe infections. To date, this is the first experience detailing distal limb gangrene in fulminant COVID infection in peri-partum women. Although, cases have been reported on distal limb gangrene in severe COVID infection among non-pregnant individuals. Conclusion:A multidisciplinary team must manage COVID infections in the third trimester. A prompt recognition of any forms of lethal coagulopathy and vigilant treatment will prevent loss of life. Keywords:Coronavirus diseaseCOVID, foot gangrene, pregnancy, coagulopathy.

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Cystic Adventitial Disease of the Common Femoral Artery: A Rare-Case Report

Frontiers in Surgery ◽

10.3389/fsurg.2021.814036 ◽

2022 ◽

Vol 8 ◽

Author(s):

Qilong Wang ◽

Zhihua Cheng ◽

Liang Tang ◽

Qi Wang ◽

Ping Zhang ◽

...

Keyword(s):

Femoral Artery ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Acute Limb Ischemia ◽

Appropriate Treatment ◽

Contrast Enhanced ◽

Rare Case Report ◽

The Right ◽

Enhanced Computed Tomography

Herein, we report the case of a 59-year-old man with intermittent claudication of ~100 m, who complained of resting pain in his lower right extremity. A pelvic, contrast-enhanced, computed tomography scan showed the presence of cystic density in the lower segment of the right common femoral artery. Faced with the risk of acute limb ischemia, we navigated a challenging diagnostic procedure to choose an appropriate treatment for him. Additionally, we performed a pathological investigation of the excised common femoral artery following the excision bypass. On postoperative day 5, the patient was discharged from the hospital. During the 2-year follow-up, no new cysts were discovered, and the patient had favorable prognosis.

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Intrathecal treatment trial of rituximab in progressive MS

Neurology ◽

10.1212/wnl.0000000000006500 ◽

2018 ◽

Vol 91 (20) ◽

pp. e1893-e1901 ◽

Cited By ~ 13

Author(s):

Joakim Bergman ◽

Joachim Burman ◽

Jonathan D. Gilthorpe ◽

Henrik Zetterberg ◽

Elena Jiltsova ◽

...

Keyword(s):

Progressive Multiple Sclerosis ◽

Intrathecal Administration ◽

Control Group ◽

Csf Biomarkers ◽

Ventricular Catheter ◽

Frontal Horn ◽

Severe Infections ◽

Phase 1B ◽

The Right

ObjectivesTo perform a phase 1b assessment of the safety and feasibility of intrathecally delivered rituximab as a treatment for progressive multiple sclerosis (PMS) and to evaluate the effect of treatment on disability and CSF biomarkers during a 1-year follow-up period.MethodsThree doses of rituximab (25 mg with a 1-week interval) were administered in 23 patients with PMS via a ventricular catheter inserted into the right frontal horn and connected to a subcutaneous Ommaya reservoir. Follow-ups were performed at 1, 3, 6, 9, and 12 months.ResultsMild to moderate vertigo and nausea were common but temporary adverse events associated with intrathecal rituximab infusion, which was otherwise well tolerated. The only severe adverse event was a case of low-virulent bacterial meningitis that was treated effectively. Of 7 clinical assessments, only 1 showed statistically significant improvement 1 year after treatment. No treatment effect was observed during the follow-up period among 6 CSF biomarkers.ConclusionsIntrathecal administration of rituximab was well tolerated. However, it may involve a risk for injection-related infections. The lack of a control group precludes conclusions being drawn regarding treatment efficacy.ClinicalTrials.gov identifierNCT01719159.Classification of evidenceThis study provides Class IV evidence that intrathecal rituximab treatment is well tolerated and feasible in PMS but involves a risk of severe infections.

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Successful Percutaneous Transcatheter Closure of a Common Femoral Artery Pseudoaneurysm With Use of MicroVascular Plug Despite Continued Catheter-Directed Thrombolysis

Vascular and Endovascular Surgery ◽

10.1177/1538574420921276 ◽

2020 ◽

Vol 54 (5) ◽

pp. 458-462

Author(s):

Reza Talaie ◽

Hamed Jalaeian ◽

Donna D’Souza ◽

Yasmina Aboufirass ◽

Jafar Golzarian

Keyword(s):

Thrombolytic Therapy ◽

Femoral Artery ◽

Treatment Options ◽

Common Femoral Artery ◽

Artery Pseudoaneurysm ◽

Catheter Directed Thrombolysis ◽

Systemic Thrombolytic Therapy ◽

Endovascular Methods ◽

Iatrogenic Pseudoaneurysm

Common femoral artery pseudoaneurysm is a known complication of percutaneous vascular access. Treatment options include surgical repair of the pseudoaneurysm or endovascular methods such as ultrasound-guided compression and direct thrombin injection into the pseudoaneurysm sac. Treatment of pseudoaneurysm is more challenging when a patient is undergoing concurrent catheter-directed or systemic thrombolytic therapy. This is a case report of endovascular treatment of an iatrogenic pseudoaneurysm of common femoral artery in a patient receiving concurrent catheter-directed thrombolytic therapy. This was performed successfully by precise deployment of a MicroVascular Plug into the pseudoaneurysm neck with immediate closure of pseudoaneurysm. Midterm follow-up confirmed sustained exclusion of the pseudoaneurysm sac with continued patency of the treated femoral artery.

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Peripheral Artery Diseases

10.2310/im.1061 ◽

2017 ◽

Author(s):

Mark A Creager

Keyword(s):

Arterial Occlusion ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Thromboangiitis Obliterans ◽

Raynaud Phenomenon ◽

Critical Ischemia ◽

Peripheral Arterial Diseases ◽

Peripheral Arterial ◽

The Right ◽

Peripheral Artery Diseases

Peripheral arterial diseases (PADs) compromise blood flow to the limbs. Common causes of arterial obstruction include atherosclerosis, thrombus, embolism, vasculitis, arterial entrapment, adventitial cysts, fibromuscular dysplasia, arterial dissection, trauma, and vasospasm. The most frequently encountered cause of PAD is peripheral atherosclerosis. This chapter considers its epidemiology and risk factors, as well as its diagnosis, including clinical presentation and noninvasive diagnostic tests. This chapter also discusses acute arterial occlusion, atheroembolism, popliteal artery entrapment, thromboangiitis obliterans, and acrocyanosis, as well as the etiology, diagnosis, and treatment of Raynaud phenomenon. The chapter contains 4 tables and 7 figures. Tables describe the Fontaine classification and clinical categories of chronic limb ischemia, provide examples of leg segmental pressure measurements in a patient with calf claudication and foot pain, and summarize secondary causes of Raynaud phenomenon. Figures include a photograph of an ischemic foot demonstrating dependent rubor, measurement of the ankle:brachial index, ultrasonography of a stenosis of the right common femoral artery, magnetic resonance angiograms of patients with calf claudication, arteriograms of critical ischemia of the foot and of disabling claudication of the leg, and ischemia of the toes caused by atheroemboli. This chapter contains 80 references.

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Peripheral Artery Diseases

10.2310/7900.1061 ◽

2012 ◽

Author(s):

Mark A Creager

Keyword(s):

Arterial Occlusion ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Thromboangiitis Obliterans ◽

Raynaud Phenomenon ◽

Critical Ischemia ◽

Peripheral Arterial Diseases ◽

Peripheral Arterial ◽

The Right ◽

Peripheral Artery Diseases

Peripheral arterial diseases (PADs) compromise blood flow to the limbs. Common causes of arterial obstruction include atherosclerosis, thrombus, embolism, vasculitis, arterial entrapment, adventitial cysts, fibromuscular dysplasia, arterial dissection, trauma, and vasospasm. The most frequently encountered cause of PAD is peripheral atherosclerosis. This chapter considers its epidemiology and risk factors, as well as its diagnosis, including clinical presentation and noninvasive diagnostic tests. This chapter also discusses acute arterial occlusion, atheroembolism, popliteal artery entrapment, thromboangiitis obliterans, and acrocyanosis, as well as the etiology, diagnosis, and treatment of Raynaud phenomenon. Tables describe the Fontaine classification and clinical categories of chronic limb ischemia, provide examples of leg segmental pressure measurements in a patient with calf claudication and foot pain, and summarize secondary causes of Raynaud phenomenon. Figures include a photograph of an ischemic foot demonstrating dependent rubor, measurement of the ankle:brachial index, ultrasonography of a stenosis of the right common femoral artery, magnetic resonance angiograms of patients with calf claudication, arteriograms of critical ischemia of the foot and of disabling claudication of the leg, and ischemia of the toes caused by atheroemboli. This review contains 4 highly rendered figures, 7 tables, and 80 references.

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Outcomes of Catheter-Directed Thrombolysis in Patients with Acute Arterial Thrombotic Limb Ischemia: A Prospective Interventional Case Series

Frontiers in Emergency Medicine ◽

10.18502/fem.v5i3.5896 ◽

2021 ◽

Author(s):

Javad Salimi ◽

Ehsan Rahimpour ◽

Hossein Zabihi Mahmoudabadi ◽

Pezhman Farshidmehr

Keyword(s):

Success Rate ◽

Treatment Success ◽

Case Series ◽

Pulmonary Hemorrhage ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Technical Success Rate ◽

Catheter Directed Thrombolysis ◽

One Year

Introduction: Acute limb ischemia is a critical medical condition that can quickly become a life threat. Therapeutic modalities such as catheter-directed thrombolysis (CDT) have demonstrated various levels of efficacy in previous studies. Objective: This study presents the descriptive findings of a series of cases who presented with acute arterial thrombotic limb ischemia and underwent CDT. Methods: This was a cross-sectional single-hospital-based case series, in which all patients who were diagnosed with acute arterial thrombotic limb ischemia, and consequently underwent CDT during the oneyear study period were included. Detailed baseline characteristics and clinical findings of the studied patients on presentation, after intervention and at one-year follow-up are presented. Results: A total of 21 patients with a mean age of 60.7±15.2 years, including 16 males (76.2%) were included. The initial technical and treatment success rates were 20 (95.2%) and 14 (66.7%), respectively. The amputation-free and the overall survival rates after the one-year follow-up were 15 (71.4%) and 17 (81%), respectively. Four patients (19%) developed complications, two (9.5%) of which were significant (pulmonary hemorrhage and intraventricular hemorrhage). Amputation was performed in 6 (28.6%) cases. Conclusion: In this study, the treatment success rate and the technical success rate were satisfactory.

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The vascular armamentarium explored-the ultimate goal achieved

International Surgery Journal ◽

10.18203/2349-2902.isj20201883 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1637

Author(s):

Manoj Prabakar Ravichandran ◽

Subrammaniyan Rathinavelpandian ◽

Marunraj Gnanasekaran ◽

Saravanan Balachandran

Keyword(s):

Skin Grafting ◽

Limb Ischemia ◽

Arterial Disease ◽

Vascular Surgeon ◽

Interventional Radiological Procedure ◽

Catheter Directed Thrombolysis ◽

Split Skin Grafting ◽

Peripheral Arterial ◽

The Right ◽

Split Skin

Peripheral arterial disease is one of the commonest causes for a limb being amputated most often, we present this case of medium vessel vasculitis with chronic threatening limb ischemia to make a note of our attempt to save her limb by multiple modalities which included medical management with steroids, immunosuppressants, pulsed cyclophosphamide, interventional radiological procedure of catheter directed thrombolysis with urokinase, surgical procedures like bypass, split skin grafting and minor amputations, implemented novel modalities like hyperbaric oxygen therapy. By exploring the armamentarium available, involving a multidisciplinary team which included vascular surgeon, rheumatologist, intervention radiologist, plastic surgeon, physiotherapist and aptly using the right modality at the right time we were able to ultimately achieve our goal of limb salvage.

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Long-term outcomes of endovascular treatment of isolated subclavian artery aneurysms

Vascular ◽

10.1177/1708538120975242 ◽

2020 ◽

pp. 170853812097524

Author(s):

Gang Fang ◽

Yuan Fang ◽

Xin Xu ◽

Jue Yang ◽

Ting Zhu ◽

...

Keyword(s):

Endovascular Treatment ◽

Subclavian Artery ◽

Treatment Strategies ◽

Limb Ischemia ◽

Surgical Trauma ◽

Covered Stents ◽

Long Term Outcomes ◽

The Right

Objectives The aim of the present study was to review our institutional experience of endovascular treatment for isolated subclavian artery aneurysms and evaluate the long-term outcomes. Methods A retrospective review of all patients with isolated subclavian artery aneurysms who underwent endovascular treatment between March 2008 and March 2020 was performed. The demographics, aneurysmal characteristics, treatment strategies, and in-hospital and follow-up outcomes were recorded and then analyzed. Results From March 2008 to March 2020, 35 isolated subclavian artery aneurysms were endovascularly treated at our institution. Atherosclerosis was the most common cause of aneurysms in this series. Most aneurysms were intrathoracic (91.4%) and located at the right side (77.1%). There were 26 true aneurysms, seven pseudoaneurysms, and two ruptured isolated subclavian artery aneurysms. Five types of endovascular strategies were performed. Covered stent placement across the aneurysm was the most (54.3%) commonly used method. Technical success was achieved in all patients. The median postoperative in-hospital stay was 4.0 days (range, 1–15 days). One patient died after discharge but within 30 days of surgery due to myocardial infarction. The median follow-up time was 62.0 months (range, 3–132 months). No death, stroke, stent fractures, or severe upper limb ischemia developed during the follow-up period. The cumulative survival rate at five years was 97.1%. The overall complication rate was 25.7% and one-third of complications (8.6%) required reinterventions. Conclusions Endovascular treatment for isolated subclavian artery aneurysms is safe, effective and technically achievable in most patients. Short- and long-term outcomes are promising. Reasonable and flexible use of covered stents can also get satisfactory outcomes in some complicated lesions such as isolated subclavian artery aneurysms located at the origin of the right subclavian artery, avoiding the huge surgical trauma caused by conventional open repair.

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Peripheral Artery Diseases

10.2310/fm.1061 ◽

2017 ◽

Author(s):

Mark A Creager

Keyword(s):

Arterial Occlusion ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Thromboangiitis Obliterans ◽

Raynaud Phenomenon ◽

Critical Ischemia ◽

Peripheral Arterial Diseases ◽

Peripheral Arterial ◽

The Right ◽

Peripheral Artery Diseases

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Kissing Stents in the Common Femoral Artery Bifurcation for Critical Limb Ischemia: Technical Description and Report of Three Cases

Vascular ◽

10.2310/6670.2007.00037 ◽

2007 ◽

Vol 15 (4) ◽

pp. 211-214 ◽

Cited By ~ 12

Author(s):

Sven Ross Mathisen ◽

Michael Åkesson ◽

Mats Lindh ◽

Krassi Ivancev ◽

Timothy A. Resch

Keyword(s):

Femoral Artery ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Common Femoral Artery ◽

Short Term ◽

Number Of Patients ◽

The Common ◽

Kissing Stent ◽

Patch Plasty

The purpose of this article is to describe three cases of kissing stent placement in the common femoral artery bifurcation in patients unsuitable for open endarterectomy and patch plasty. In three patients with critical limb ischemia, caused by primary atherosclerotic disease or dissection-related injury when performing a lower extremity intervention, a technique of kissing stents was used to treat the flow-obstructing lesion in the common femoral artery bifurcation. Technical success was uniform, and during follow-up (4.5–8 months), all patients showed improved symptoms, wound healing, and duplex ultrasonography–verified patency of the stents. Kissing stents in the common femoral artery bifurcation are a feasible treatment option in patients with limited mobililty or contraindications to open repair. The short-term results seem promising, but longer follow-up and an increased number of patients will be needed to assess the durability of the reconstruction.

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