A retrospective analysis of COVID-19 patients presented with vascular problems: a single center experience

Authors

  • Kartik Datta Kolli Department of Vascular Surgery, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Sriperumbudur, Tamil Nadu, India http://orcid.org/0000-0001-6020-8522
  • Subrammaniyan Rathinavel Pandian Department of Vascular Surgery, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Sriperumbudur, Tamil Nadu, India
  • Marun Raj Gnanasekaran Department of Vascular Surgery, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Sriperumbudur, Tamil Nadu, India
  • Manoj Prabakar Ravichandran Department of Vascular Surgery, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Sriperumbudur, Tamil Nadu, India
  • Kamaraj Raja Department of Vascular Surgery, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Sriperumbudur, Tamil Nadu, India
  • Ratnasri Ravipati Department of Vascular Surgery, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Sriperumbudur, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20221578

Keywords:

COVID-19, PAD, VTE, DVT, Acute limb ischemia

Abstract

Background: The aim of the study was to analyse clinical, biochemical parameters and treatment outcomes of COVID-19 patients with vascular disease.

Methods: Retrospective analysis of data of COVID patients from May 2020 until July 2021.

Results: 7 patients had arterial disease alone, 3 arterial and venous, 4 venous alone. Mean age of patients with arterial disease was 52. 80% were diabetic, 30% hypertensive, 30% thyroid disorders. 10% past CVA, 10% had past PAD history. 10% had history of tobacco consumption. 50% had severe and 20% had moderate COVID, 30% were post discharge. Mean duration of presentation was 20.1±18.6 days after COVID diagnosis; mean duration of symptoms 8.8±11.8 days. 50% femoro-popliteal segment and 20% iliac segment was involved. 10% each were subclavian, axillary and brachial occlusions. Mean±SD CRP, ESR and D-dimer at admission were 74.36±71.35, 97±38.5 and 1360±1538 respectively. 3 surgical, 1 medical intervention resulted in limb salvage in 4 patients (9.25 month follow up; 2 upper, 2 lower limb). 3 patients required trans-tibial or above amputations. Death occurred in 2 patients.  The four patients with COVID induced VTE had no comorbidities, presented mean 5.75 days of symptom onset; COVID diagnosis mean 23.33 days prior. External iliac to popliteal vein was the most common pattern (75%).  Mean CRP and ESR were lower than in the arterial cases. One patient underwent IVC filter placement and CDT; for another IVC filter was placed.  All four were discharged uneventfully.

Conclusions: Patients who developed arterial disease mostly had comorbidities, more severe COVID disease and higher mean inflammatory markers.

Author Biographies

Kartik Datta Kolli, Department of Vascular Surgery, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Sriperumbudur, Tamil Nadu, India

Post graduate, Department of Vascular Surgery

Subrammaniyan Rathinavel Pandian, Department of Vascular Surgery, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Sriperumbudur, Tamil Nadu, India

Professor and Head of Department, Department of Vascular Surgery

Marun Raj Gnanasekaran, Department of Vascular Surgery, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Sriperumbudur, Tamil Nadu, India

Professor, Department of Vascular Surgery

Manoj Prabakar Ravichandran, Department of Vascular Surgery, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Sriperumbudur, Tamil Nadu, India

Assistant Professor, Department of Vascular Surgery

Kamaraj Raja, Department of Vascular Surgery, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Sriperumbudur, Tamil Nadu, India

Assitant Professor, Department of Vascular Surgery

Ratnasri Ravipati, Department of Vascular Surgery, Saveetha Medical College and Hospital, Saveetha Nagar, Thandalam, Sriperumbudur, Tamil Nadu, India

Post graduate, Department of Vascular Surgery

References

Nopp S, Moik F, Jilma B, Pabinger I, Ay C. Risk of venous thromboembolism in patients with COVID-19: A systematic review and meta-analysis. Res Pract Thromb Haemost. 2020;4(7):1178-91.

Bellosta R, Luzzani L, Natalini G, Pegorer MA, Attisani L, Cossu LG, et al. Acute limb ischemia in patients with COVID-19 pneumonia. J Vasc Surg. 2020;72(6):1864-72.

Etkin Y, Conway AM, Silpe J, Qato K, Carroccio A, Singh P, et al. Acute Arterial Thromboembolism in Patients with COVID-19 in the New York City Area. Ann Vasc Surg. 2021;70:290-4.

Fournier M, Faille D, Dossier A, Mageau A, Nicaise Roland P, Ajzenberg N, et al. Arterial Thrombotic Events in Adult Inpatients With COVID-19. Mayo Clin Proc. 2021;96(2):295-303.

Talasaz AH, Sadeghipour P, Kakavand H, Aghakouchakzadeh M, Kermani E, Tassell BW, et al. Recent Randomized Trials of Antithrombotic Therapy for Patients With COVID-19: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;77(15):1903-21.

Libby P, Lüscher T. COVID-19 is, in the end, an endothelial disease. Eur Heart J. 2020;41(32):3038-44.

Giustino G, Pinney SP, Lala A, Reddy VY, Johnston-Cox HA, Mechanick JI, et al. Coronavirus and Cardiovascular Disease, Myocardial Injury, and Arrhythmia: JACC Focus Seminar. J Am Coll Cardiol. 2020;76(17):2011-23.

Skendros P, Mitsios A, Chrysanthopoulou A, Mastellos DC, Metallidis S, Rafailidis P, Ntinopoulou M, et al. Complement and tissue factor-enriched neutrophil extracellular traps are key drivers in COVID-19 immunothrombosis. J Clin Invest. 2020;130(11):6151-7.`

Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135(23):2033-40.

Koupenova M. Potential role of platelets in COVID-19: Implications for thrombosis. Res Pract Thromb Haemost. 2020;4(5):737-40.

Siddiqi HK, Libby P, Ridker PM. COVID-19 - A vascular disease. Trends Cardiovasc Med. 2021;31(1):1-5.

Stefely JA, Christensen BB, Gogakos T, Cone Sullivan JK, Montgomery GG, Barranco JP, et al. Marked factor V activity elevation in severe COVID-19 is associated with venous thromboembolism. Am J Hematol. 2020;95(12):1522-30.

Becker RC. COVID-19 update: Covid-19-associated coagulopathy. J Thromb Thrombolysis. 2020;50(1):54-67.

Zuo Y, Zuo M, Yalavarthi S, Gockman K, Madison JA, Shi H, Woodard W, Lezak SP, Lugogo NL, Knight JS, Kanthi Y. Neutrophil extracellular traps and thrombosis in COVID-19. J Thromb Thrombolysis. 2021;51(2):446-53.

Jin S, Jin Y, Xu B, Hong J, Yang X. Prevalence and Impact of Coagulation Dysfunction in COVID-19 in China: A Meta-Analysis. Thromb Haemost. 2020;120(11):1524-35.

Singhania N, Bansal S, Nimmatoori DP, Ejaz AA, McCullough PA, Singhania G. Current Overview on Hypercoagulability in COVID-19. Am J Cardiovasc Drugs. 2020;20(5):393-403.

Katneni UK, Alexaki A, Hunt RC, Schiller T, DiCuccio M, Buehler PW, et al. Coagulopathy and Thrombosis as a Result of Severe COVID-19 Infection: A Microvascular Focus. Thromb Haemost. 2020;120(12):1668-79.

Marchandot B, Trimaille A, Curtiaud A, Carmona A, Matsushita K, Sato C, et al. Staging Severity of COVID-19 according to Hemostatic Abnormalities (CAHA Score). Thromb Haemost. 2020;120(12):1716-9.

Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med. 2020;383(2):120-8.

Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study. Ann Intern Med. 2020;173(4):268-77.

Szekely Y, Lichter Y, Taieb P, Banai A, Hochstadt A, Merdler I, et al. Spectrum of Cardiac Manifestations in COVID-19: A Systematic Echocardiographic Study. Circulation. 2020;142(4):342-53.

Giustino G, Croft LB, Stefanini GG, Bragato R, Silbiger JJ, Vicenzi M, et al. Characterization of Myocardial Injury in Patients With COVID-19. J Am Coll Cardiol. 2020;76(18):2043-55.

NIH. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines, 2021. Available at: https://files.covid19treatmentguidelines.nih.gov/guidelines/covid19treatmentguidelines.pdf. Accessed on 10 May 2022.

Hess CN, Huang Z, Patel MR, Baumgartner I, Berger JS, Blomster JI, et al. Acute Limb Ischemia in Peripheral Artery Disease. Circulation. 2019 Aug 13;140(7):556-65.

Bonaca MP, Bauersachs RM, Anand SS, Debus ES, Nehler MR, Patel MR, et al. N Engl J Med. 2020;382(21):1994-2004.

Ilonzo N, Rao A, Safir S, Vouyouka A, Phair J, Baldwin M, et al. Acute thrombotic manifestations of coronavirus disease 2019 infection: Experience at a large New York City health care system. J Vasc Surg. 2021;73(3):789-96.

Indes JE, Koleilat I, Hatch AN, Choinski K, Jones DB, Aldailami H, et al. Early experience with arterial thromboembolic complications in patients with COVID-19. J Vasc Surg. 2021;73(2):381-9.

Rastogi A, Dogra H, Jude EB. COVID-19 and peripheral arterial complications in people with diabetes and hypertension: A systematic review. Diabetes Metab Syndr. 2021;15(5):102204.

Mascia D, Kahlberg A, Melloni A, Rinaldi E, Melissano G, Chiesa R. Single-Center Vascular Hub Experience after 7 weeks of COVID-19 Pandemic in Lombardy (Italy). Ann Vasc Surg. 2020;69:90-9.

Topcu AC, Ozturk-Altunyurt G, Akman D, Batirel A, Demirhan R. Acute Limb Ischemia in Hospitalized COVID-19 Patients. Ann Vasc Surg. 2021;74:88-94.

Borrelli MP, Buora A, Scrivere P, Sponza M, Frigatti P. Arterial Thrombotic Sequalae After Covid-19: Mind the Gap. Ann Vasc Surg. 2021;75:128-35.

Surya SP, Santoso RM. A clinical case series of COVID-19-associated acute limb ischemia: real-world situation. Egypt Heart J. 2021;73(1):59.

Veerasuri S, Kulkarni SR, Wilson WR, Paravastu SCV. Bilateral Acute Lower Limb Ischemia Secondary to COVID-19. Vasc Endovascular Surg. 2021;55(2):196-9.

Max Wohlauer M, RPVI, Yana Etkin, MD, FACS. UpToDate, 2021. Available from: https://www.uptodate.com/contents/covid-19-acute-limb-ischemia. Accessed on 10 May 2022.

Bonaca MP, Gutierrez JA, Creager MA, Scirica BM, Olin J, Murphy SA, et al. Acute Limb Ischemia and Outcomes With Vorapaxar in Patients With Peripheral Artery Disease: Results From the Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients With Atherosclerosis-Thrombolysis in Myocardial Infarction 50 (TRA2°P-TIMI 50). Circulation. 2016;133(10):997-1005.

Baril DT, Patel VI, Judelson DR, Goodney PP, McPhee JT, Hevelone ND, et al. Outcomes of lower extremity bypass performed for acute limb ischemia. J Vasc Surg. 2013;58(4):949-56.

Inagaki E, Farber A, Kalish JA, Eslami MH, Siracuse JJ, Eberhardt RT, Rybin DV, Doros G, Hamburg NM; Vascular Study Group of New England. Outcomes of Peripheral Vascular Interventions in Select Patients With Lower Extremity Acute Limb Ischemia. J Am Heart Assoc. 2018;7(8):e004782.

Cassidy MR, Rosenkranz P, McAneny D. Reducing postoperative venous thromboembolism complications with a standardized risk-stratified prophylaxis protocol and mobilization program. J Am Coll Surg. 2014;218(6):1095-104.

Cronin M, Dengler N, Krauss ES, Segal A, Wei N, Daly M, et al. Completion of the Updated Caprini Risk Assessment Model (2013 Version). Clin Appl Thromb Hemost. 2019 Jan-;25:1076029619838052.

Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in Hospitalized Patients With COVID-19 in a New York City Health System. JAMA. 2020;324(8):799-801.

Downloads

Published

2022-06-27

Issue

Section

Original Research Articles