The experience of a vascular service in the Anglo-Caribbean with COVID-19 associated arterial thrombosis- A case series

Introduction

This study aimed to examine the characteristics and clinical outcomes of coronavirus (COVID-19) positive patients presenting with acute limb ischemia (ALI) during the coronavirus pandemic.

Design and methods

A multi-center, observational study was undertaken. It included patients from three tertiary parallel healthcare facilities in Trinidad and Tobago who were COVID-19 positive and had an acute thromboembolic event between August 2020 and April 2022. The data was collected in a prospectively maintained database.

Results

Over the 21 months, 24 patients with ALI and were infected with COVID-19 were evaluated, analyzing 25 consecutive limbs. The cohort's median age was 62.2 years (42–88 years), of which 62.5% were male. The most common comorbidities were diabetes (45.8%) and hypertension (33.3%). 12.5% (3/24) of patients’ initial manifestation was acute arterial ischemia, with the remaining patients (87.5%) developing signs of ALI during their hospitalization for their COVID-19 infection. Additionally, 12.5% (3/24) of patients were found to have had extremity thrombosis at multiple levels. Treatment arms were categorized as medical (N= 16), surgical (open surgery 7, and endovascular 2) management. There were no major adverse limb events in patients treated surgically. Non-surgical management was more prevalent in severe cases of Covid-19 disease in 37.5%. The in-hospital mortality was 41.7% (the leading cause of death being acute respiratory distress syndrome and multiorgan failure), all of whom were managed medically.

Conclusion

COVID-19 posed unique challenges in the management of ALI, with increased mortality and primary amputation rates. However, in patients who underwent surgical revascularization, there was a 100% major amputation-free survival at 24 months.