Department of Vascular Surgery, Countess of Chester NHS Foundation Trust, Chester, UK.
Department of Vascular Surgery, Countess of Chester NHS Foundation Trust, Chester, UK.
Ann Vasc Surg. 2021 Feb;71:103-111. doi: 10.1016/j.avsg.2020.09.044. Epub 2020 Nov 3.
A 49-year-old man was admitted to his local hospital with left leg pain and breathing difficulties. He had negative nasopharyngeal polymerase chain reaction tests for severe acute respiratory syndrome coronavirus 2. Chest X-ray and Computed tomography pulmonary angiogram displayed typical coronavirus disease 2019 (COVID-19) radiological features as ground-glass opacities and bronchovascular thickening. His respiratory symptoms resolved after four days of supportive treatment, whereas his left leg became more painful and discolored. He was referred to our center with acute left leg ischemia. computed tomography angiogram revealed eccentric mural thrombus at the aortic bifurcation, extending into left common iliac and an abrupt occlusion of left popliteal, tibioperoneal, and posterior tibial arteries. He was treated with catheter-directed thrombolysis for 48-hours that achieved successful revascularization of the ischemic limb with no intervention-related complications. At six-week follow-up, he showed full recovery. Our case demonstrates that catheter-directed thrombolysis is a successful and safe treatment option in a COVID-19 patient with acute arterial occlusion.
一位 49 岁男性因左腿疼痛和呼吸困难入住当地医院。他的鼻咽聚合酶链反应检测严重急性呼吸综合征冠状病毒 2 呈阴性。胸部 X 光和计算机断层肺动脉造影显示出典型的 2019 年冠状病毒病（COVID-19）放射学特征，包括磨玻璃影和支气管血管增厚。经过四天的支持性治疗，他的呼吸症状得到缓解，但左腿变得更加疼痛和变色。他因急性左腿缺血被转至我们中心。计算机断层血管造影显示主动脉分叉处偏心性壁血栓形成，延伸至左侧髂总动脉，以及左侧腘动脉、胫前动脉和后胫动脉突然闭塞。他接受了 48 小时的导管定向溶栓治疗，实现了缺血肢体的成功再血管化，没有与干预相关的并发症。在 6 周的随访中，他完全康复。我们的病例表明，在 COVID-19 患者中，导管定向溶栓是一种成功且安全的治疗选择。
