ABSTRACT:
Background: The COVID-19
pandemic is responsible for huge morbidity and mortality throughout the
world. Several serious complications of this disease have been reported.
It can cause hypercoagulability, which may lead to venous and arterial
thromboembolic diseases. This hypercoagulability state is also
associated with high morbidity and mortality. Arterial thrombosis in
COVID-19 is poorly described compared to venous thrombosis and pulmonary
embolism. We report a case of an extensive arterial thrombosis leading
to a limb ischemia with extremely high D-dimer in a COVID-19 patient.
Case presentation: A 69-year-old man was hospitalized for
febrile dyspnea. He is a hypertensive and diabetic patient. On
admission, pulse oxygen saturation was 72% on room air. He had cyanosis
of the left foot up to the mid-thigh. The left pedal, posterior tibial,
popliteal and femoral pulses were abolished. Chest CT scan was in favour
of COVID-19. He has a high D-dimer level of 257 344 ng/ml. Arterial
Echo-Doppler found an extensive intraluminal thrombus along the arterial
axes of the left lower limb, completely obstructing them, starting from
the primitive iliac artery just after its bifurcation with the aorta and
extending distally (external iliac; common femoral; superficial femoral;
popliteal; anterior tibial; posterior tibial; fibular and pedal). The
patient was diagnosed with COVID-19 critical form, associated with
ischemia of the left lower limb secondary to an extensive arterial
thrombosis. He was receiving anticoagulation, and underwent surgical
amputation of the ischemic limb. The patient survived the event;
however, he was on long-term oxygen therapy at home.
Conclusions: Arterial thrombosis may occur during COVID-19 and
may be responsible for peripheral or central ischemia aggravating
morbidity and mortality. The occurrence of these events is related to
the D-dimer value. Anticoagulation is an important part of the
management of COVID-19, especially in severe forms in order to limit the
occurrence of these thromboembolic diseases.
Key words: COVID-19, D-dimer, ischemia, arterial thrombosis,
case report