Preoperative evaluation
According to our standardized program, all patients with a clinical suspicion for aortoiliac and/or infrainguinal ALI and/or upper limb ischemia underwent routine preoperative screening blood tests, including creatine phosphokinase and D-dimer, and chest radiographs and electrocardiography. Preoperative computed tomography was performed to identify COVID-19-related pneumonia (Fig 1 ). These studies were performed in the emergency room to avoid cross-contamination and unnecessary risk of viral spread. Patients with suspected aortoiliac occlusion underwent computed tomography angiography to assess the extent of disease and vessel size (Fig 2 , A and B). Those patients who had presented with infrainguinal and/or upper limb occlusive disease underwent echocardiographic color Doppler evaluation of both the arterial and the venous systems. Also, during the course of hospitalization, all patients were screened for the identification of eventual cardiac emboli sources using transthoracic echocardiography. The operative risk profile was determined using a multidisciplinary evaluation, which included the physical examination and laboratory blood test results.
Fig 1 Preoperative computed tomography scan of a 66-year-old man with COVID-19-related pneumonia and acute limb ischemia. Transverse and coronal thin-section scans show extensive ground-glass opacities of both lungs.
Fig 2 Preoperative computed tomography angiography with volume rendering 3-dimensional reconstruction (A) showing the presence of intraluminal thrombus (B) at the infrarenal aorta (white arrow), total occlusion of the popliteal segment (white dotted arrows), and the absence of tibial vessels, bilaterally. Final completion angiogram showing the morphological aspect of “desert foot” after large amount of thrombus removal for femoral-popliteal-tibial occlusion that required selective thrombectomy of all tibial vessels bilaterally.