Costa Víctor de Oliveira, de Almeida Guilherme Bicalho Civinelli, Nicolini Eveline Montessi, Rodrigues Guilherme de Abreu, da Costa Bruna Malaquias Arguelles, Carvalho Guilherme Heluey, Dos Reis Álvaro Luiz Segregio, Colen Davi Pinto
Faculdade de Ciências Médicas e da Saúde de Juiz de Fora and Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
Vascular Surgery, Hospital Monte Sinai and Hospital Universitário da Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
Int J Surg Case Rep. 2020;77:454-458. doi: 10.1016/j.ijscr.2020.11.046. Epub 2020 Nov 11.
COVID-19 infection may predispose to venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilization and disseminated intravascular coagulation; however, there are few reports of lower limb ischemia as the main manifestation of the disease.
Male patient, 69 years old, asthmatic, ex-smoker and bearer of systemic arterial hypertension, has been admitted to the emergency department with sudden onset of pain in the right lower limb (RLL), associated with cyanosis and reduced temperature of the limb. He has been tested for COVID-19 in the OR with positive result for IGG and IGM. Computed tomography angiography (AngioCT) was performed, showing signs of arterial embolization to both limbs, right internal iliac artery, and superior mesenteric artery. Faced with the threat of limb loss and the absence of signs and symptoms of visceral ischemia, the patient underwent full anticoagulation and RLL thromboembolectomy and tricompartmental fasciotomy. He was discharged after 7 days of hospitalization and demonstrated no other signs and symptoms of COVID-19, following outpatient follow-up.
COVID-19 is associated with high risk of thrombotic complications being related to the clinical severity of the patient, with few studies that show symptoms of sudden pain in the lower limb without other complaints.
Individuals infected with COVID-19 are at risk for arterial thromboembolic events, and knowledge of such cases is essential in order to create specific protocols for prophylaxis of thrombotic events in these patients, in addition to increasing the suspicion of infection in individuals with acute arterial occlusion, mostly during pandemic times.
由于过度炎症、缺氧、制动和弥散性血管内凝血，新型冠状病毒肺炎（COVID-19）感染可能易导致静脉和动脉血栓栓塞；然而，以下肢缺血为该疾病主要表现的报道较少。
一名69岁男性患者，有哮喘病史，既往吸烟，患有系统性动脉高血压，因右下肢突然疼痛并伴有肢体发绀和温度降低而入住急诊科。他在手术室接受了COVID-19检测，IGG和IGM结果均为阳性。进行了计算机断层扫描血管造影（AngioCT），显示双下肢、右髂内动脉和肠系膜上动脉有动脉栓塞迹象。面对肢体丧失的威胁且无内脏缺血的体征和症状，患者接受了充分抗凝治疗以及右下肢血栓切除术和三个间隔的筋膜切开术。住院7天后出院，门诊随访显示无其他COVID-19的体征和症状。
COVID-19与血栓形成并发症的高风险相关，这与患者的临床严重程度有关，很少有研究显示下肢突发疼痛而无其他不适症状。
感染COVID-19的个体有发生动脉血栓栓塞事件的风险，了解此类病例对于制定针对这些患者的血栓形成事件预防的特定方案至关重要，此外，在大流行期间，对于急性动脉闭塞的个体，应提高对感染的怀疑。
