Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.200071
Jornal Vascular Brasileiro
Case Report

COVID-19 diagnosis in a patient with critical limb ischemia: complications and clinical outcomes

Diagnóstico de COVID-19 em paciente com isquemia crítica do membro: complicações e desfechos clínicos

Rafael de Athayde Soares; Rafael Salem Vedovello; Samanta Christine Guedes de Medeiros; Celso Zaffani Nunes; Carlos Alberto Sian; Paulo Daenekas de Melo Jorge

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Abstract

Abstract: A 67-year-old male diabetic patient with systemic arterial hypertension was admitted to the emergency department with a necrotic ulcer in the left external malleolus and no palpable popliteal or pedal pulses. Arterial Duplex ultrasound identified femoropopliteal occlusion, with popliteal refilling below the knee and a patent peroneal artery. An endovascular procedure was performed, requiring retrograde access to the popliteal artery to re-establish blood flow and deploy a popliteal stent. Technical success was achieved and the patient underwent debridement of the wound. Two days later, about 48 hours after the operation, the patient began to exhibit respiratory symptoms, with coughing and dyspnea. He immediately underwent a chest CT that identified ground glass opacities, the crazy-paving pattern, and bilateral air bronchogram in the lungs. A reverse transcription – polymerase chain reaction (RT-PCR) test was positive for SARS-Cov-2. The patient was moved to an intensive care unit and put on mechanical ventilation. Both hydroxychloroquine and azithromycin were administered. Despite appropriate treatment, the patient died 4 days after he was diagnosed with COVID-19.

Keywords

COVID-19, critical limb ischemia, endovascular surgery, angioplasty, peripheral occlusive arterial disease, gangrene

Resumo

Resumo: Paciente do sexo masculino, 67 anos, diabético, hipertenso, foi admitido no pronto-socorro com histórico de úlcera necrótica no maléolo externo esquerdo, sem pulsos poplíteos e distais palpáveis. A ultrassonografia Doppler arterial identificou oclusão femoropoplítea, com reenchimento da artéria poplítea infragenicular e perviedade da artéria fibular. Foi realizado procedimento endovascular, com necessidade de acesso retrógrado na artéria poplítea para restabelecer o fluxo sanguíneo e realizar implante de stent poplíteo. O sucesso técnico foi alcançado e, em seguida, o paciente foi submetido ao desbridamento da ferida. No segundo dia, cerca de 48 horas de pós-operatório, o paciente apresentou quadro respiratório com tosse e dispneia. Foi submetido a uma tomografia computadorizada do tórax, que identificou opacidades em vidro fosco e broncograma aéreo bilateralmente nos pulmões, com teste de reverse transcription – polymerase chain reaction (RT-PCR) positivo para SARS-Cov-2. O paciente foi transferido para uma unidade de terapia intensiva, necessitando de ventilação mecânica. Recebeu hidroxicloroquina e azitromicina. Apesar do tratamento em suporte intensivo, o paciente morreu 4 dias após o diagnóstico de COVID-19.
 

Palavras-chave

COVID-19, isquemia crítica, tratamento endovascular, angioplastia, doença arterial obstrutiva periférica, gangrena

References

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Submitted date:
05/16/2020

Accepted date:
06/29/2020

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