Severe acute limb ischemia in patients with COVID-19: A single-center case series.

OBJECTIVES

Acute limb ischemia (ALI) is a severe complication of COVID-19. Following the lifting of COVID-19 restrictions in China in December 2022, increasing cases of ALI were observed.

AIM: To describe the clinical features of severe COVID-19-associated ALI and evaluate diagnostic and management strategies.

METHODS

A single-center retrospective study was conducted from December 2022 to March 2023. Among 78 COVID-19-infected ALI patients, 7 severe cases (Rutherford grade III) were included. Clinical characteristics, laboratory findings, treatments, and outcomes were analyzed. Given the small sample size and short study period, the present study should be interpreted as a descriptive case series.

RESULTS

Patients aged <60 years appeared to have a shorter admission time compared with those aged >60 years. Fever was the most common COVID-19 symptom, and lower-limb ulceration was the predominant ischemic manifestation. Laboratory findings showed neutrophilia, lymphopenia, elevated d-dimer, fibrinogen, hs-CRP, and PCT, with decreased albumin levels. Antibiotics were effective in most cases with open wounds. Surgical debridement with pedicled flap transplantation reduced amputation and mortality rates.

CONCLUSION

Severe COVID-19-associated ALI has poor prognosis. Altered coagulation, inflammatory, and myocardial markers aid diagnosis. Debridement combined with pedicled flap transplantation offers favorable therapeutic outcomes.