Tables I and II summarize four cases presenting with acute critical limb ischemia in patients testing COVID-19 (+) with no previous vascular consultations or symptoms. We identified a delayed diagnosis for the entire group. The patients were either extremely fearful about coming to the hospital or underdiagnosed during hospitalization, as confirmed with written commentary from nurses. An arterial thrombotic event presented in two COVID-19 patients who were asymptomatic despite testing positive for the disease. Blood testing demonstrated a high inflammatory response in all of these patients (D-dimer, C-reactive protein) that was significantly higher in those who were hospitalized with active and severe pneumonia. Interestingly, procalcitonin values were normal in all of these patients, indicating an evolving inflammatory condition. Although no strong conclusions can be drawn from this initial description, it may serve as guidance for future studies seeking to improve PAD identification.
Table I Clinical data and outcomes of patients with acute critical limb ischemia (ACLI) and COVID-19 (+)
Age, years Other COVID-19 symptomsa Vascular bed affected Treatment Outcome
1 72 COPD, HT + Popliteal artery (right) LMWH alone Death 1 day after consultationDIC + MOF
2 53 – – Iliac and popliteal artery (left) LMWH and delayed thrombectomy at day 7 Clinical improvement
3 72 DM – SFA, popliteal with distal thrombosis (right) Thrombectomy + LMWH + prostaglandins 10-day limb salvage, 50% ischemic neuropathy
4 70 PV + Infragenicular (right) LMWH alone 2 days—clinical improvement
COPD, Chronic obstructive pulmonary disease; DIC, disseminated intravascular coagulopathy; DM, diabetes mellitus; HT, hypertension; LMWH, low-molecular-weight heparin; MOF, multiorgan failure; PV, polycythemia; SFA, superficial femoral artery.
a Includes respiratory or fever.
Table II Blood test data of patients with acute critical limb ischemia (ACLI) and COVID-19 (+)
D-dimer, ng/mL Platelet count, 109 L Lymphocytes count, /mm3 CRP, mg/dL
1 6531 50 900 184
2 1415 335 800 9.1
3 3235 228 1800 58.9
4 7528 121 400 77.7
CRP, C-reactive protein.