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This is growing evidence confirming the association between COVID-19 and arterial thrombotic events. Various studies have shown that infection with COVID-19 causes clots to form in the arteries which are responsible for transporting oxygen-rich blood to the body from the heart, and this can be called arterial thrombosis. Many post-Covid patients have suffered from limb and life-threatening blood clots in the arteries of the legs. Arterial thrombosis induced due to COVID-19 infection is characterized by disastrous outcomes, dramatically increased amputation and death rates.
Dr Rahul Sheth, Interventional Radiologist, Zen Multispeciality Hospital, Mumbai said he treated 24 patients for lower limb arterial clots at the hospital. “We were able to save 17 limbs, where no amputation was necessary. 7 patients required some form of amputation because they presented late. Of the 24 patients, 2 presented in the first wave and 22 in the second wave, “he said. noted.
Explaining the COVID-19 infection and the arterial thrombotic link, he said: “It is postulated that Covid-19 increases the viscosity of the blood causing clots. When the blood flow in the artery is blocked due to the clots, there is no supply of oxygen to parts of the body.When this affects the legs it can lead to severe pain in the legs, cold limbs and, if left 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 prompt follow-up, early detection of symptoms and prompt treatment will prevent complications and limbs can be saved from gangrene and amputation.
According to the expert, symptoms will be noticeable sometimes during active COVID or sometimes even 7-10 days after recovery from COVID. The golden period to be treated is within 24 hours of the onset of symptoms.
He warned that all symptoms such as leg pain, pain when walking, cold limbs should not be ignored and a doctor should be consulted.
Examination of the affected leg and palpation of the pulse of the foot should be performed. If pulses are absent, immediate admission should be performed, followed by arterial color Doppler. This color doppler is like an ultrasound for the blood vessels to detect the blockage. Then, peripheral angiography is done 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 an anticoagulant drug is given to dissolve the clots; or surgical in which an incision is made in the artery and the clot removed with a device. Endovascular is preferred today because clots in the small blood vessels in the leg and foot can also be removed, explained Dr Sheth.
“There is no awareness of this disease and patients ignore the early symptoms. Some come to the hospital at an advanced stage with skin discoloration or gangrene. The first 12 to 24 hours of symptoms are crucial, blood circulation must be restored; ideally, the earlier the better. Do not suffer from severe leg pain or casually abnormal changes in the body during the post-covid period, “said Dr Sheth.
A post-covid patient who suffered arterial thrombosis
A 46-year-old woman from Zion, Mumbai, who had a medical history of hypertension and obesity tested positive for Covid on March 21, 2021. She was admitted to Zen Multispeciality Hospital in Mumbai on March 27 202. According to the doctors there, she had a fever with cough, her Covid pneumonia CT score was 8/25 and the oxygen saturation was 92%, and needed 4 liters of oxygen. She was treated with steroids and Remdesivir for 6 days. She recovered well and her saturation was 98% in ambient air without shortness of breath. The patient was discharged on day 10 on oral steroids, antibiotics and ecosprin during the first week of April.
But 9 days after her release, she felt pain in her left foot. She took pain medication, but nothing seemed to work in her favor. To her dismay, 24 hours later, the pain worsened. An orthopedist recommended an arterial color 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 arrived with severe pain in her left leg, her leg and foot were cold, and her toes were discolored. After examination, clots were found in the arteries of the left leg. With a special catheter, the doctors sucked out the clots and administered blood thinning medication to dissolve the clots in the legs. This medication was given over 12 hours through a catheter in the leg. They then repeated an angiogram which showed almost complete clearance of the clots. Now the pain is gone and her foot is warm to the touch. The impulses in the foot are back and she can move her toes as before.
The patient urged other patients like her to be careful and to avoid delaying treatment.
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