Acute Limb Ischemia in COVID-19 Patients: A Retrospective Cohort Study

This study aimed to show the incidence, presentation, management, and outcome of acute limb ischemia (ALI) in patients diagnosed with COVID-19 pneumonia, and prove the association between them. A multi-centre retrospective cohort study in the middle and south of Iraq, comparing 400 patients admitted to the isolation hospitals for COVID-19 pneumonia with a matched control group at period from 1st June 2020 to 1st August 2020. A total of 21/400 cases of ALI in COVID-19 pneumonia and only 4/400 cases in the non-COVID-19 group. Relative Risk (Risk Ratio= 5.25, 95%CI=1.818-15.157, P = 0.001). There were 291 (72.7%) males and 109 (27.2%) females. The average time from diagnosis of COVID-19 to the onset of ALI was (9.4±6.4 days). The mean ischemic time was (22.05 ±18.8 hours) in the COVID-19 group, while it was (11.75±8.7 hours) in the non-COVID-19 group. The mean D-dimer level for the patient with COVID-19 pneumonia without ALI is (1705±1256 μg/L), while it is (3730±2373 μg/L) for the patient with COVID-19 pneumonia. The embolectomy done in 14 patients (66.6%) of the COVID-19 pneumonia group, and it was successful in 10 patients (71.4%). In comparison, it was done in 3 patients (75%) of the control group and was successful in 2 (66.6%). Amputation was done in 4 patients (19%) of the COVID-19 pneumonia group, while only one patient (25%) in the control group had amputation. The association between COVID-19 pneumonia and ALI incidence; the D-dimer level is also associated with ALI in COVID-19 pneumonia cases. The anticoagulants, antiplatelet, vasodilators, and embolectomy had a management success rate.