Recurrent, Acute Limb Ischemia Secondary to Arterial Thrombosis: A Devastating Complication in the Setting of Severe COVID-19 Infection.

Background: COVID-19 infection, particularly with the Delta variant, has been associated with a heightened risk of thromboembolic events due to a profound hypercoagulable state. While venous thrombosis is more commonly reported, arterial thrombosis-including acute limb ischemia-has emerged as a serious complication with significant morbidity and mortality.

Case presentation: We report the case of a 53-year-old man with severe COVID-19 pneumonia who developed recurrent acute limb ischemia secondary to an aortic mural thrombus. Despite therapeutic anticoagulation and multiple surgical interventions-including thrombectomy, angioplasty, and stenting-the patient experienced repeated episodes of arterial thrombosis. His clinical course was further complicated by pneumothorax and hemothorax, ultimately resulting in cardiopulmonary arrest and death.

Conclusion: This case highlights the aggressive and resistant nature of arterial thrombosis in the setting of severe COVID-19. Recurrent arterial thrombosis in severe COVID-19 underscores the need for early recognition and aggressive anticoagulation strategies. Further research is warranted to establish protocols for thromboembolic prevention in this high-risk population.