Recurrent, Acute Limb Ischemia Secondary to Arterial Thrombosis: A Devastating Complication in the Setting of Severe COVID-19 Infection.

BACKGROUND

COVID-19 infection, particularly with the Delta variant, has been associated with a heightened risk of thromboembolic events due to a profound hypercoagulable state. While venous thrombosis is more commonly reported, arterial thrombosis-including acute limb ischemia-has emerged as a serious complication with significant morbidity and mortality.

CASE PRESENTATION: We report the case of a 53-year-old man with severe COVID-19 pneumonia who developed recurrent acute limb ischemia secondary to an aortic mural thrombus. Despite therapeutic anticoagulation and multiple surgical interventions-including thrombectomy, angioplasty, and stenting-the patient experienced repeated episodes of arterial thrombosis. His clinical course was further complicated by pneumothorax and hemothorax, ultimately resulting in cardiopulmonary arrest and death.

CONCLUSION

This case highlights the aggressive and resistant nature of arterial thrombosis in the setting of severe COVID-19. Recurrent arterial thrombosis in severe COVID-19 underscores the need for early recognition and aggressive anticoagulation strategies. Further research is warranted to establish protocols for thromboembolic prevention in this high-risk population.