SARS-CoV-2 Related Acute Limb Ischemia and Systemic Thrombosis
Speaker Credentials
Medical Education
Speaker Credentials
MD
Format
Poster
Start Date
6-11-2020 10:45 AM
End Date
6-11-2020 11:00 AM
Abstract
SARS-CoV-2 Related Acute Limb Ischemia and Systemic Thrombosis Daniel High, MD¹, Nicolas Hanabergh, MD² ¹Internal Medicine Resident, Aventura Hospital and Medical Center ²Internal Medicine Faculty, Aventura Hospital and Medical Center Introduction. SARS-CoV-2 causes a poorly understood prothrombotic state that leads to thrombotic sequela in potentially any organ. Case Description. A 48-year-old male presented with 10 hours of right leg pain, weakness, and numbness. Exam revealed cool right leg and absent pulses below the common femoral artery, 1+ strength on dorsiflexion/plantarflexion and an unremarkable left lower extremity. CT angiography revealed occlusion of right common femoral artery with reconstitution and distal occlusion of the popliteal artery, posterior tibial artery, and peroneal artery; complete occlusion of the left anterior tibial artery (secondary to distant trauma). CT Brain and Venous Ultrasound were unremarkable. Emergent revascularization was performed using catheter directed alteplase at the right common femoral and popliteal arteries with concurrent peripheral heparin drip running in the ICU overnight. By morning, leg pain and strength had improved and pulses were present via doppler but there was new left facial droop so alteplase and heparin were stopped. CT Brain was negative for bleeding and MRI contraindicated by left ankle plating. TIA symptoms resolved within 1 hour. Repeat angiogram showed only partial resolution so open thrombectomy was performed, restoring palpable pulses throughout the limb. Hospital protocol pre-op SARS-CoV-2 PCR returned positive the following day. Patient was found to have uncontrolled diabetes, hypertension, and HFrEF (20%) likely secondary to NSTEMI present on admission. Patient was discharged on warfarin on hospital day 10. Discussion. Risk factors for critical limb ischemia were present, however, concurrent multi-organ system thrombotic disease is explained by acute corona viral infection.
SARS-CoV-2 Related Acute Limb Ischemia and Systemic Thrombosis
SARS-CoV-2 Related Acute Limb Ischemia and Systemic Thrombosis Daniel High, MD¹, Nicolas Hanabergh, MD² ¹Internal Medicine Resident, Aventura Hospital and Medical Center ²Internal Medicine Faculty, Aventura Hospital and Medical Center Introduction. SARS-CoV-2 causes a poorly understood prothrombotic state that leads to thrombotic sequela in potentially any organ. Case Description. A 48-year-old male presented with 10 hours of right leg pain, weakness, and numbness. Exam revealed cool right leg and absent pulses below the common femoral artery, 1+ strength on dorsiflexion/plantarflexion and an unremarkable left lower extremity. CT angiography revealed occlusion of right common femoral artery with reconstitution and distal occlusion of the popliteal artery, posterior tibial artery, and peroneal artery; complete occlusion of the left anterior tibial artery (secondary to distant trauma). CT Brain and Venous Ultrasound were unremarkable. Emergent revascularization was performed using catheter directed alteplase at the right common femoral and popliteal arteries with concurrent peripheral heparin drip running in the ICU overnight. By morning, leg pain and strength had improved and pulses were present via doppler but there was new left facial droop so alteplase and heparin were stopped. CT Brain was negative for bleeding and MRI contraindicated by left ankle plating. TIA symptoms resolved within 1 hour. Repeat angiogram showed only partial resolution so open thrombectomy was performed, restoring palpable pulses throughout the limb. Hospital protocol pre-op SARS-CoV-2 PCR returned positive the following day. Patient was found to have uncontrolled diabetes, hypertension, and HFrEF (20%) likely secondary to NSTEMI present on admission. Patient was discharged on warfarin on hospital day 10. Discussion. Risk factors for critical limb ischemia were present, however, concurrent multi-organ system thrombotic disease is explained by acute corona viral infection.