The outbreak forced us to rearrange our therapeutic protocols to deal with the novel discoveries regarding SARS-CoV-2, which seemed to interact with the coagulation cascade [21]. We noticed an increased number of patients with increased risk of thrombosis. Not only did patients with a known chronic peripheral arteriopathy suffer from acute ischaemia, but some healthy patients had completely obliterated peripheral arteries, causing an increase in patients coming to the ER. Vascular surgeons in Monzino, together with their colleagues from Brescia, implemented a new shared protocol for treating patients with COVID-19 with acute limb ischaemia (Fig. 5). They combined surgical and pharmacological therapy using different doses and timing of intravenous heparin administration and intralesion thrombolysis, related to the higher risk of recurrences and worse clinical pictures showed by these patients [22]. The previously described emergency SARS-CoV-2-positive patient, despite long-term therapy with an oral anticoagulant, had acute ischaemia. Moreover, he also had long-term therapy with cortisone, currently part of COVID-19 therapy [23, 24], and irbesartan, even if its protective role is still being discussed [25, 26]. It is possible that his long-term therapy had a protective role with a milder course of the disease, despite the limb ischaemia.