key: cord-0958592-m0reiq9z authors: Bhoriwal, Sandeep; Dhall, Kunal; Gamit, Prafull Kumar; Deo, S.V.S. title: Acute arterial thrombosis in a breast cancer survivor with coronavirus disease 2019 (COVID-19) date: 2020-07-07 journal: Surgery DOI: 10.1016/j.surg.2020.06.019 sha: af23906282b8e69d97045bdcd8abd11d06e5852e doc_id: 958592 cord_uid: m0reiq9z nan The coronavirus disease 2019 (COVID-19) outbreak caused by the novel coronavirus (SARS-CoV-2), which originated in Wuhan (China), has now spread across the globe affecting Q2 millions of people worldwide. 1 COVID-19 is a hypercoagulable state and may lead to both venous and arterial thromboembolic events. 2 This state is more common in cancer patients owing to an immunosuppressed state. 3 Therefore, a thorough evaluation of the vascular system is warranted in these patients. A 60-year-old female patient with no comorbidities complained of pain and discoloration of her right hand 3 days after being web 4C=FPO 8 9 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 diagnosed with COVID-19. She had a previous history of locally advanced carcinoma of the left breast 4 years ago for which she underwent neoadjuvant chemotherapy (through peripherally inserted central line in her right upper limb). This was followed by mastectomy, radiation therapy, and hormonal therapy. The patient had been disease free for the last 3.5 years. On physical examination, the right upper limb was cold with the right hand showing gangrenous changes (Fig 1, A and B) . The brachial and radial artery pulsations were not palpable. Ultrasound Doppler of the right upper limb demonstrated a 6-cm-long thrombus at the bifurcation of the brachial artery and extending into the proximal part of the ulnar and radial arteries. There was no obvious color flow seen in the radial and ulnar arteries. Because the patient had a poor general condition with an Q3 Eastern Cooperative Oncology Group performance status of 2, the patient was managed conservatively with heparin, aspirin, cilostazol, and pentoxifylline. A surgical intervention was not contemplated because the risk of reperfusion injury was considered greater than the risk associated with thrombectomy. COVID-19 induced thrombosis has been observed most commonly in lower limbs followed by upper limbs and mesenteric vessels. 2, 4, 5 However, the incidence of venous thrombosis is greater than that of arterial thrombosis in COVID-19. 2 Cancer patients, particularly those who receive chemotherapy, are at a higher risk for arterial thrombosis and maintain a subclinical hypercoagulable state. 6 Whether this hypercoagulability is exacerbated during COVID-19 needs to be evaluated further. None . 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 The epidemiology, diagnosis and treatment of COVID-19 Incidence of thrombotic complications in critically ill ICU patients with COVID-19 Coagulopathy of Coronavirus Disease 2019 Acute upper limb ischemia in a patient with COVID-19 Arterial and venous abdominal thrombosis in a 79-year-old woman with COVID-19 pneumonia Oncology Task Force. Arterial thrombosis in cancer: Spotlight on the neglected vessels None.