Arterial Thrombosis Associated With COVID-19 Can Cause Limb Amputation, Death
This is growing evidence confirming the association between COVID-19 and arterial thrombotic events. Various studies have shown that COVID-19 infection leads to clots in the arteries that are responsible for carrying oxygen-rich blood to the body from the heart, and this can be termed arterial thrombosis. Many post-Covid patients have suffered from limb and life-threatening blood clots in the arteries of the legs. The arterial thrombosis induced owing to COVID-19 infection is characterized by dire outcomes, strikingly increased rates of amputation and death.
Dr Rahul Sheth, Interventional Radiologist, Zen Multispeciality Hospital, Mumbai said that they have treated 24 patients for lower limb arterial clots in the hospital. "We have been able to save 17 limbs, where no amputation was required. 7 patients required some form of amputation since they presented late. Out of the 24 patients, 2 presented in the first wave, and 22 in the second wave," he said.
Explaining about the COVID-19 infection and arterial thrombotic link, he stated, "It is postulated that Covid-19 increases the blood's viscosity of the blood causing clots. When the blood flow in the artery is blocked due to the clots, there is no oxygen supply to the body parts. When this affects the legs, it can lead to severe leg pain, cold limbs and if untreated will progress to gangrene, requiring amputation or removal of the limb to save the patient's life. These blood clots can also travel all over the body and damage distant organs."
Early symptoms of arterial thrombosis to watch out for
Dr Sheth noted that timely follow-up, early detection of symptoms, and prompt treatment will prevent complications and the limbs can be saved from gangrene setting in and amputation.
According to the expert, the symptoms will be noticeable sometimes during active COVID or sometimes even 7 to 10 days post COVID recovery. The golden period to treat is within 24 hours after the onset of the symptoms.
He cautioned that any symptoms like leg pain, pain in walking, the cold limbs should not be ignored, and a doctor should be consulted.
Examination of the affected leg and palpation of the foot pulses should be done. If the pulses are absent, then immediate admission should be done, followed by an arterial colour Doppler. This colour doppler is like sonography for the blood vessels to detect the blockage. Then, a peripheral angiography is performed to confirm the diagnosis and decide on a treatment plan. Two main options are there; endovascular, where the clots are removed using a special catheter and a clot-busting drug is given to dissolve the clots; or surgical wherein an incision is made in the artery and the clot removed using a device. Endovascular is preferred nowadays since the clots in the small blood vessels in the leg and foot can also be cleared Dr Sheth elaborated.
"There is no awareness regarding this condition and the patients ignore the early symptoms. Some come to the hospital in advanced stages with discolouration of skin or gangrene. The first 12 to 24 hours of symptoms are crucial, blood circulation needs to be restored; ideally earlier the better. Don't take severe leg pain or any abnormal changes in the body casually, during the post-covid period," asserted Dr Sheth.
A post-covid patient who suffered arterial thrombosis
A 46-year-old woman from Sion, Mumbai, who had a past medical history of hypertension and obesity was tested Covid positive on March 21, 2021. She was admitted to Zen Multispeciality Hospital, Mumbai on 27th March 202. According to doctors there, she had fever with cough, her Covid pneumonia CT score was 8/25 and oxygen saturation was 92%, and needed 4 litres of oxygen. She was treated with the help of steroids and Remdesivir for 6 days. She recovered well and her saturation was 98% on room air with no breathlessness. The patient was discharged on day 10 on oral steroids, antibiotics, and ecosprin in the first week of April.
But 9 days post-discharge, she experienced pain in the left foot. She took pain killers, but nothing seemed to work in her favour. To her dismay, 24 hours later pain worsened. An orthopaedic advised her an arterial colour doppler, which revealed clots (thrombosis) in the main artery supplying the leg (the superficial femoral artery), with poor blood flow in the leg.
According to doctors at Zen Multispeciality Hospital, she came with severe left leg pain, the leg and foot were cold with the toes showing discolouration. After examination, clots were found in the left leg arteries. With a special catheter, the doctors aspirated the clots and gave a clot-busting drug to dissolve the leg clots. This drug was given for 12 hours through a catheter in the leg. They then repeated an angiogram which showed near total clearance of the clots. Now, the pain has disappeared, and her foot feels warm to the touch. The pulses in the foot are back, and she can move her toes like before.
The patient urged other patients like her to be careful and avoid delaying treatment.