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An extensive arterial thrombosis with lower limb ischemia in a COVIDâ19 patient: A case report
Key Clinical Message The coronavirus disease 2019 (COVIDâ19) 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 COVIDâ19 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 Dâdimer in a COVIDâ19 patient. A 69âyearâold 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 midâthigh. The left pedal, posterior tibial, popliteal and femoral pulses were abolished. Chest CT scan was in favor of COVIDâ19. He has a high Dâdimer level of 257,344âng/mL. Arterial EchoâDoppler 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 COVIDâ19 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 longâterm oxygen therapy at home. Arterial thrombosis may occur during COVIDâ19 and may be responsible for peripheral or central ischemia aggravating morbidity and mortality. The occurrence of these events is related to the Dâdimer value. Anticoagulation is an important part of the management of COVIDâ19, especially in severe forms in order to limit the occurrence of these thromboembolic diseases