Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202200441
Jornal Vascular Brasileiro
Case Report

Diagnóstico e manejo de isquemia aguda de membro em paciente pós infecção viral por covid-19: série de casos

Diagnosis and management of patients with acute limb ischemia after Covid-19 infection: a case series

Jamisson Garrote Teixeira; Guilherme Benjamin Brandão Pitta; Cézar Ronaldo Alves da Silva; Lucigl Regueira Teixeira; Gregório Luís Guarnieri Panazzolo; Joaquim Araújo Sampaio; Anna Karoline Rocha de Sousa; Claubiano Cipriano Moura

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Resumo

Resumo: A pandemia causada pela doença do coronavírus 2019 (covid-19) estabeleceu desafios e estimulou o desenvolvimento de diferentes formas terapêuticas em várias áreas médicas. Estudos descreveram características clínicas e desfechos de pacientes, incluindo desordens do sistema de coagulação, em que os pacientes infectados pelo vírus apresentam um estado de hipercoagulabilidade e pró-inflamatório que mimetiza uma vasculite. O objetivo deste trabalho foi descrever o quadro clínico e a terapia empregada em uma série de três pacientes que evoluíram com quadro de oclusão arterial aguda no período pós-infecção por covid-19. O manejo aplicado nesses casos permitiu que os pacientes evoluíssem sem sequelas. A baixa incidência e a pobreza em relatos descritos tornam difícil o estabelecimento de critérios e opções terapêuticas universalmente aceitos nos casos de isquemia, seja precoce ou tardia, dos pacientes infectados pelo novo coronavírus.

Palavras-chave

covid-19, trombose, anticoagulantes, isquemia, extremidade inferior, extremidade superior

Abstract

The Covid-19 pandemic caused by the Sars-Cov-2 virus created challenges and stimulated development of new forms of treatment in many different areas of medicine. Studies have described the clinical characteristics of patients and their outcomes, including disorders affecting the coagulation system, in which patients infected by the virus enter a hypercoagulable and proinflammatory state that mimics vasculitis. The objective of this study was to describe the clinical status and the treatment administered to three patients who developed acute arterial occlusion after Covid-19 infection. The management adopted in these cases enabled the patients to recover without sequelae. The low incidence and scarcity of published reports make it difficult to establish universally accepted treatment criteria and options for cases of ischemia in patients infected with the novel coronavirus, whether presenting early or late.

Keywords

Covid-19; thrombosis; anticoagulants; ischemia; lower limb; upper limb.

References

1 McGonagle D, Bridgewood C, Ramanan AV, Meaney JFM, Watad A. Covid-19 vasculitis and novel vasculitis mimics. Lancet Rheumatol. 2021;3(3):E224-33. http://dx.doi.org/10.1016/S2665-9913(20)30420-3. PMid:33521655.

2 Becker RC. Covid-19-associated vasculitis and vasculopathy. J Thromb Thrombolysis. 2020;50(3):499-511. http://dx.doi.org/10.1007/s11239-020-02230-4. PMid:32700024.

3 Rossi FH. Tromboembolismo venoso em pacientes COVID-19. J Vasc Bras. 2020;19:e20200107. http://dx.doi.org/10.1590/1677-5449.200107. PMid:34211527.

4 Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):e438-40. http://dx.doi.org/10.1016/S2352-3026(20)30145-9. PMid:32407672.

5 Shah A, Donovan K, McHugh A, et al. Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study. Crit Care. 2020;24(1):561. http://dx.doi.org/10.1186/s13054-020-03260-3. PMid:32948243.

6 Guarinello GG, D’Amico RC, Miranda ANM, Novack J, Coral FE. Impacto da COVID-19 no perfil cirúrgico dos pacientes de cirurgia vascular em serviço de referência em Curitiba. J Vasc Bras. 2022;21:e20220027. PMid:35677745.

7 Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-81. http://dx.doi.org/10.1016/S2213-2600(20)30079-5. PMid:32105632.

8 Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7. http://dx.doi.org/10.1111/jth.14768. PMid:32073213.

9 Han H, Yang L, Liu R, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020;58(7):1116-20. http://dx.doi.org/10.1515/cclm-2020-0188. PMid:32172226.

10 Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID19. Lancet. 2020;395(10234):1417-8. http://dx.doi.org/10.1016/S0140-6736(20)30937-5. PMid:32325026.

11 Costa VO, Almeida GBC, Nicolini EM, et al. Acute arterial occlusion of the lower limb as the main clinical manifestation in a patient with Covid-19 - case report. Int J Surg Case Rep. 2020;77:454-8. http://dx.doi.org/10.1016/j.ijscr.2020.11.046. PMid:33200062.

12 Bellen BV. Oclusão arterial aguda de membro superior. In: Brito CJ, editor. Cirurgia vascular. Rio de Janeiro: Thieme Revinter Publicações; 2020. p. 1333-6.

13 Alonso MN, Mata-Forte T, García-Léon N, et al. Incidence, characteristics, laboratory findings and outcomes in acro-ischemia in COVID-19 patients. Vasc Health Risk Manag. 2020;16:467-78. http://dx.doi.org/10.2147/VHRM.S276530. PMid:33262599.

14 Poissy J, Goutay J, Caplan M, et al. Pulmonary embolism in COVID-19 patients: awareness of an increased prevalence. Circulation. 2020;142(2):184-6. http://dx.doi.org/10.1161/CIRCULATIONAHA.120.047430. PMid:32330083.

15 Zhou B, She J, Wang Y, Ma X. A case of coronavirus disease 2019 with concomitant acute cerebral infarction and deep vein thrombosis. Front Neurol. 2020;11:296. http://dx.doi.org/10.3389/fneur.2020.00296. PMid:32390931.

16 Macedo VSO, Moreira GB, Albuquerque ACF, Oliveira SCS, Esmeraldo MA, Barbosa FCB. Late mesenteric ischemia after Sars-Cov-2 infection: case report. J Vasc Bras. 2021;20:e20200105. http://dx.doi.org/10.1590/1677-5449.200105. PMid:34093678.

17 Woehl B, Lawson B, Jambert L, Tousch J, Ghassani A, Hamade A. 4 cases of aortic thrombosis in patients with COVID-19. JACC Case Rep. 2020;2(9):1397-401. http://dx.doi.org/10.1016/j.jaccas.2020.06.003. PMid:32835285.

18 Levolger S, Bokkers RPH, Wille J, Kropman RHJ, Vries JPPM. Arterial thrombotic complications in COVID-19 patients. J Vasc Surg Cases Innov Tech. 2020;6(3):454-9. http://dx.doi.org/10.1016/j.jvscit.2020.06.012. PMid:32835150.

19 Eshaq AM, Almofadhli AA, Aljarba NK, Karish MA. Acute limb ischemia as a concomitant manifestation of COVID-19. Cureus. 2022;14(1):e21032. http://dx.doi.org/10.7759/cureus.21032. PMid:35155000.

20 Nespola M, Sirignano P, Fermani N, et al. Treatment-resistant acute upper limb ischemia in a patient with systemic lupus erythematous and concomitant SARS-CoV-2 infection: a case report. Ann Vasc Surg. 2021;76:289-92. http://dx.doi.org/10.1016/j.avsg.2021.05.012. PMid:34182111.

21 Teng E, Pignanelli M, Hammad F, Wisa DA. COVID-19 patient with recurrent acute limb ischaemia despite two successive types of therapeutic dose anticoagulation and thrombolysis. BMJ Case Rep. 2021;14(8):e245040. http://dx.doi.org/10.1136/bcr-2021-245040. PMid:34389601.

22 Bellosta R, Luzzani L, Natalini G, et al. Acute limb ischemia in patients with COVID-19 pneumonia. J Vasc Surg. 2020;72(6):1864-72. http://dx.doi.org/10.1016/j.jvs.2020.04.483. PMid:32360679.

23 Rosa FD, Burihan MC, Simões EA, Abdala JPS, Barros OC, Nasser F. Isquemia arterial aguda de membros superiores em pacientes diagnosticados com COVID-19: série de casos. J Vasc Bras. 2021;20:e20200234. http://dx.doi.org/10.1590/1677-5449.200234. PMid:34211540.

24 Galyfos G, Sianou A, Frountzas M, et al. Acute limb ischemia among patients with COVID-19 infection. J Vasc Surg. 2022;75(1):326-42. http://dx.doi.org/10.1016/j.jvs.2021.07.222. PMid:34390791.

25 Ramacciotti E, Macedo AS, Biagioni RB, et al. Evidence-based practical guidance for the antithrombotic management in patients with Coronavirus disease (COVID019) in 2020. Clin Appl Thromb Hemost. 2020;26:1-8. http://dx.doi.org/10.1177/1076029620936350. PMid:32649232.

26 Baril DT, Ghosh K, Rosen AB. Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population. J Vasc Surg. 2014;60(3):669-77. http://dx.doi.org/10.1016/j.jvs.2014.03.244. PMid:24768362.
 


Submitted date:
04/01/2022

Accepted date:
09/15/2022

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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