Sri Krishnasevasharama Hospital, Bangalore, India.
Ann R Coll Surg Engl. 2022 Jul;104(7):e211-e215. doi: 10.1308/rcsann.2021.0342. Epub 2022 Apr 21.
A new variant of coronavirus (2019-nCoV) causing acute respiratory distress in humans was identified for the first time in 2019, in Wuhan, China. One of the many complications of infection with this coronavirus is hypercoagulopathy, resulting in acute thrombosis; often leading to acute limb ischaemia. Herein, we report 20 cases of COVID-19 with peripheral arterial thrombosis involving either upper or lower limbs. Some patients underwent vascular procedures and most had to undergo amputation at some level. All the cases (=20) were referred to us during the 8-month period June 2020 to March 2021. The most common age group was between 51 and 60 years, of whom 80% were males; all the patients had diabetes. The right lower limb was most affected (50%); 15 patients underwent embolectomy. Twenty-five per cent of patients presented with wet gangrene. One patient with upper limb thrombosis recovered after embolectomy and did not require any amputation. Eighty-five per cent of patients underwent some form of amputation and the mortality rate was 10%. Arterial thrombosis is one complication patients may develop during COVID-19 illness, which may affect the outcome. Patients with comorbid conditions like diabetes are at higher risk of developing arterial thrombosis during COVID-19 infection. Susceptibility to coagulopathy may continue even after patient discharge and it is important that both patients and treating physicians are aware of this limb-threatening complication and seek early medical attention.
一种新型冠状病毒(2019-nCoV)于 2019 年在中国武汉首次被发现,可导致人类急性呼吸窘迫。这种冠状病毒感染的众多并发症之一是高凝状态,导致急性血栓形成;常导致急性肢体缺血。在此,我们报告了 20 例 COVID-19 合并外周动脉血栓形成的病例,累及上肢或下肢。部分患者接受了血管介入治疗,大多数患者需要进行某种程度的截肢。所有病例(=20)均在 2020 年 6 月至 2021 年 3 月期间转诊至我们处。最常见的年龄组在 51-60 岁之间,其中 80%为男性;所有患者均患有糖尿病。最常见的受累部位是右下肢(50%);15 例行取栓术。25%的患者出现湿性坏疽。1 例上肢血栓形成患者取栓后痊愈,无需截肢。85%的患者接受了某种形式的截肢,死亡率为 10%。动脉血栓形成是 COVID-19 患者可能出现的并发症之一,可能影响患者的预后。合并糖尿病等合并症的患者在 COVID-19 感染期间发生动脉血栓形成的风险更高。即使在患者出院后,仍可能存在易发生凝血病的倾向,患者及其治疗医生都应了解这种危及肢体的并发症,并尽早寻求医疗关注。