Clinical Spectrum, Management Strategies, and Outcomes of Abdominal and Limb Vascular Ischemia in COVID-19: An Observational Study
DOI:
https://doi.org/10.37506/swj7ew94Keywords:
covid- 19 bowel ischemia, covid 19 limb ischemiaAbstract
COVID-19 exhibits wide spectrum of clinical manifestations, from mild symptoms to severe thrombotic events-death. Vascular coagulopathy plays critical role in severe complications. Patients with pre-existing peripheral vascular disease (PVD) are at heightened risk due to endothelial dysfunction, inflammation, and prothrombotic state. Present study aimed to evaluate vascular complications associated with COVID-19 & assess role of antithrombotic agents & corticosteroids during early (golden) stage of infection.
Methods: This observational study was conducted in Department of General Surgery at D.Y. Patil School of Medicine, Nerul, Navi Mumbai, from Jan 2021–Dec 2022. 20 patients with confirmed COVID-19 & vascular ischemia involving abdomen and/or limbs were enrolled based on RT-PCR results, CT Severity Scores (CT-SS >5), CORADS >5, antibody positivity, and/or previous history of PVD. Detailed clinical assessment, laboratory investigations, imaging (Doppler studies, CECT, CT angiography), operative procedures, postoperative outcomes recorded. Patients followed for 1month post-discharge. Statistical analysis performed using SPSS v21, with Chi-square tests applied for categorical variables (p<0.05 considered significant). Mean age was 55.1 ± 11.9 years, with 75% males. Comorbidities included hypertension (25%), diabetes (10%), diabetes with hypertension (15%), other combinations including hypothyroidism, tuberculosis, and IHD (5% each). Laboratory abnormalities included elevated CRP, D-dimer, PT, leukocytosis (5% each). Imaging revealed SMA thrombosis as most frequent thrombus site (25%), followed by femoral artery involvement (15%). Surgical interventions included exploratory laparotomy with resection/anastomosis (15%), laparotomy with ileostomy (15%), right below-knee amputation (15%), femoropopliteal grafting (5%), and thromboembolectomy (5%), while 20% were managed conservatively. 17 patients (85%) were fully vaccinated, yet thrombotic events were still observed. Statistically significant association was found between thrombus location & surgical procedure performed (p=0.031). No significant association was observed between prior use of antiplatelet agents and diagnosis (p=0.154).
Conclusion: COVID-19 associated with significant vascular complications, particularly SMA thrombosis and femoropopliteal involvement, even in fully vaccinated patients. Early imaging, prompt diagnosis, and timely surgical intervention are crucial to prevent limb loss and improve survival. While antiplatelet use did not significantly impact thrombus occurrence, further multicentric studies with larger sample sizes are needed to clarify preventive role of antithrombotic therapy and vaccination in mitigating vascular complications.
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