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Background Acute limb ischemia is defined as a decrease in blood perfusion to the limbs caused by blockages in peripheral arteries. Coronavirus disease 19 (COVID 19), declared as a pandemic by WHO, affects not only respiratory system but also other organs including cardiovascular system. Patients mainly manifests as venous thromboembolism, while peripheral arteries blockages is less common. Case Summary A 53 years old man came to emergency room complaining of pain in his left leg. It was felt since the third day of treatment at the previous hospital, in Tuban, as a covid patient one month ago. The first and third of his left toes were also blackish. There was no history of hypertension, diabetes or smoking. On laboratory result, D-dimer level was elevated by 745 ng/ml (normal range &amp;lt;500 ng/ml), while the others within normal limit. CT Angiography examination showed bilateral legs arterial thrombus which the left side was worse. A thrombectomy was performed, then heparin therapy intravenously was given. During observation at the 4th day after surgery, the sign of necrotic border in the 1st dan 3rd toes were seen clearer and we decided to do mutilation. Discussion The pathophysiology of acute limb ischemia in Covid-19 patients is known multifactorial, including endothelial damage, immobilization and hypercoagulable states that have a role in the occurrence of blockages. They may also have an acute thrombosis of non atherosclerotic native arteries. An immediate anticoagulants and vascular interventions are needed to reduce its morbidities.

C4. Acute Limb Ischemia in Covid-19 Patient : A Rare Case Report from Rural to Tertiary Hospital