key: cord-0940988-0wc7rcq2 authors: Pasqui, Edoardo; de Donato, Gianmarco; Brancaccio, Brenda; Casilli, Giulia; Ferrante, Giulia; Palasciano, Giancarlo title: Misdiagnosed Acute Limb Ischaemia in three non-hospitalized patients recovering from a non-severe COVID-19 infection date: 2021-05-25 journal: Ann Vasc Surg DOI: 10.1016/j.avsg.2021.04.029 sha: 76fea447d485a8d061a53ca049882c873d0fe193 doc_id: 940988 cord_uid: 0wc7rcq2 The incidence of venous and arterial thromboembolic complications in COVID-19 patients is significant. The vast majority of COVID-19 patients spend their quarantine at home in a self-isolation condition. The occurrence of Acute limb ischaemia (ALI) is a dangerous event that needs prompt diagnosis and management with time-dependent recanalization outcomes. We present a case series of three COVID-19 patients who suffered from ALI that occurred during home self-isolation, and that were diagnosed and treated with a significant time-delay due to COVID-19 social implications. ABSTRACT: The incidence of venous and arterial thromboembolic complications in COVID-19 patients is significant. The vast majority of COVID-19 patients spend their quarantine at home in a selfisolation condition. The occurrence of Acute limb ischaemia (ALI) is a dangerous event that needs prompt diagnosis and management with time-dependent recanalization outcomes. We present a case series of three COVID-19 patients who suffered from ALI that occurred during home self-isolation, and that were diagnosed and treated with a significant time-delay due to COVID-19 social implications. The novel Sars-CoV-19 pandemic has affected the globe, changing every dimension of society. Since the beginning of 2020 national healthcare systems have faced an unprecedented emergency. in the last 12 months, an enormous number of studies have been published regarding COVID-19 infection, highlighting the systemic impact that this virus can have on infected patients. The incidence of coagulopathy disorders in COVID-19 patients have gained substantial interest. Hypercoagulable state in patients with COVID-19 has been demonstrated by several studies [2] , highlighting the negative impact that thromboembolic events could have on mortality rates. In addition to an increased incidence of vein thromboembolism [3] , a higher number of Acute Limb Ischaemia (ALI) have been also observed. [4, 5] In Italy, the number of patients with severe COVID-19 infection has been one of the highest globally. Luckily, the vast majority of patients are followed at home with no need for hospitalization and intensive care observation. These patients have different needs with different follow-up protocols. In this perspective, with this paper, we want to report a series of three patients who have recovered from a non-hospitalized non-severe COVID-19 infection with subacute limb ischemia that occurred during quarantine and were diagnosed and treated with a significant delay. (Table I) All subjects gave informed consent and the ethical committee of the hospital was informed of the no-experimental of the study and it. A 78-year-old-male patient with a previous medical history of idiopathic myelofibrosis JAK-2correlated and no reported thromboembolic events, presented to our emergency department with right leg pain, foot cyanosis and poikilothermia. A Rutherford IIb ALI grade was defined. ( On the 13th post-operative day after first intervention, an above-the-knee amputation was performed due to a newly complete occlusion and progression of distal gangrene and worsening of general clinical status. (Figure 1-B) The hospitalization continued uneventfully, and the patient was discharged home in stable condition on the 21st postoperative day. Increased level of D-dimer, decreased prothrombin time and increased activated partial thromboplastin time are some of the most common coagulative alterations found. [7] The management of ALI remains troubling, with a high risk of severe morbidity, high rates of deaths and limb loss. [8] The correct and prompt diagnosis and treatment are essential to reach technical and clinical success. COVID-19 has determined a complete rearrangement of the healthcare system and homecare. [9, 10] Non-severe COVID-19 patients are mostly treated at home with scheduled medical examination trying to reduce the already high pressure on tertiary hospitals. COVID-19 pandemic, consecutive social limitations and self-isolation have contributed to a critical evolution and worsening of chronic [11, 12] and acute disease with consecutive impact of their management. In our paper, we presented three cases of subacute limb ischemia that occurred during the final part of patients' domiciliary quarantine. The occurrence of ALI in COVID-19 patients is not a novelty, and its diagnosis and treatment can be challenging even in hospitalized patients. [13, 14, 15] All patients arrived at our attention after a significant delay that may jeopardize the COVID-19 and Multiorgan Response The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management Deep Vein Thrombosis in Hospitalized Patients With COVID-19 in Acute limb ischemia in patients with COVID-19 pneumonia Aortic Thrombosis in the Course of Covid-19 Disease; Two Rare Cases Safety and Efficacy of Vacuum Assisted Thrombo-Aspiration in Patients with Acute Lower Limb Ischaemia: The INDIAN Trial Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia Acute on chronic limb ischemia: From surgical embolectomy and thrombolysis to endovascular options Vascular Surgery During COVID-19 Emergency in Hub Hospitals of Lombardy: Experience on 305 Patients The impact of COVID-19 pandemic on surgical residency programmes in Italy: a nationwide analysis on behalf of the Italian Polyspecialistic Young Surgeons Society (SPIGC) The Limitations of Social Behaviour Imposed by CoVid-19 Impacted the Perception and the Evolution of Peripheral Arterial Disease Negatively Impact of the COVID-19 Lockdown Strategy on Vascular Surgery Practice: More Major Amputations than Usual A Case of Rapidly Progressive Upper Limb Ischemic Necrosis in a Patient with COVID-19 Acute Limb Ischemia in Hospitalized Symptomatic arterial thrombosis associated with novel coronavirus disease 2019 (COVID-19): report of two cases