COVID induced acute ischaemic limb
File(s)
Accepted version
Author(s)
Shah, B
Kedrzycki, M
Type
Conference Paper
Abstract
The coronavirus pandemic has overwhelmed healthcare systems worldwide, with more than 40 million affected and 1 million deaths. In addition to the typical symptoms, less clinically obvious was the underlying hypercoagulable state, termed COVID-19 associated coagulopathy (CAC). The exact mechanism of CAC is unknown, but it is suspected to involve all three aspects of Virchow’s Triad: endothelial injury, stasis, and a hypercoagulable state. Here we report the case of a woman in her 60’s who was admitted with COVID-19 and developed CAC with subsequent complications. She presented with a 3-day history of fevers, severe shortness of breath, and cough. Past medical history was significant for hypertension, poorly controlled insulin dependant diabetes, and obesity. She was admitted with COVID induced type 2 respiratory failure (pO2 of 5.5 on 15L), DKA (ketones 2.1), AKI (Cr 163), and a hypercoagulable state (D-dimer >20 000). She was intubated and commenced on an insulin sliding scale, therapeutic anticoagulation, and antibiotics. On day 2 she became anuric, with CT-angio demonstrating thrombus extending from renal arteries down to the right popliteal artery. She underwent an embolectomy and 4 compartment fasciotomy and was started on renal replacement therapy. Unfortunately, her leg was not deemed viable, and due to persistent hyperkalaemia required amputation 2 days later. She continued to deteriorate despite maximal multiple organ support and was palliated 15 days later. CAC can have life-threatening sequelae, and patients with COVID-19 infection should be commenced on anticoagulation upon diagnosis.
Date Issued
2021-10-12
Date Acceptance
2021-10-01
Citation
British Journal of Surgery, 2021, 108, pp.1-1
ISSN
0007-1323
Publisher
British Journal of Surgery Society
Start Page
1
End Page
1
Journal / Book Title
British Journal of Surgery
Volume
108
Copyright Statement
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model). This article has been published in a revised form in British Journal of Surgery https://doi.org/10.1093/bjs/znab259.285. This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model). This article has been published in a revised form in British Journal of Surgery https://doi.org/10.1093/bjs/znab259.285. This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works.
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000711212700488&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Source
2021 Association of Surgeons in Training International Surgical Conference
Subjects
Science & Technology
Life Sciences & Biomedicine
Surgery
Publication Status
Published
Start Date
2021-03-05
Coverage Spatial
Virtual Event
Date Publish Online
2021-10-12