Treatment details
Three patients (15%) did not undergo revascularization. These patients had had severe COVID-19-related pneumonia, and intervention was not performed owing to their moribund condition (mean oxygen pressure, 47 mm Hg; mean SVS score, 8.3; and Rutherford stage III [2 patients]). Operative treatment was performed in 17 patients (85%). Local anesthesia with sedation was used for 15 patients (88.2%) and locoregional anesthesia for two patients (11.8%). Thromboembolectomy was performed for infrainguinal occlusion in 11 patients (64.7%), bilateral aortoiliac occlusion in 3 patients (17.6%), and upper limb occlusion in 1 patient (5.9%). Below-the-knee femoropopliteal bypass was performed in two patients (11.8%). Selective tibial vessel thrombectomy was performed in five patients (29.4%) and additional intraoperative thrombolysis in four patients (23.5%). Adjunctive procedures included placement of aortoiliac kissing stents in 2 patients because of nondetachable residual clots, femoral endarterectomy in 1 patient, and below-the-knee popliteal percutaneous transluminal angioplasty in 1 patient. At completion angiography, no critical chronic atherosclerotic obstructive lesion was observed and no anastomotic defects were observed in the surgical or endovascular graft already implanted. Postoperatively, all patients received systemic anticoagulation with a weight-adjusted therapeutic regimen of low-molecular-weight heparin (n = 11) or intravenous heparin infusion (n = 6). No bleeding complications were observed. All the patients had macroscopic evidence of black- and gray-striped thrombus (Fig 3 ). All thrombi were sent for histologic examination.
Fig 3 Thrombus (A and B) specimen after aortoiliac-femoropopliteal thrombectomy and bilateral selective tibial artery thrombectomy.