Acute limb ischaemia in two young, non-atherosclerotic patients with COVID-19. Perini P, Nabulsi B, Massoni CB, Azzarone M, Freyrie A. Coagulation abnormalities and thrombosis in patients with COVID-19. Since COVID-19 patients are at increased risk for arterial occlusion, it appears advisable to meticulously check for adequacy of collateral (hand-) perfusion, avoiding the harm of hand ischemia if interventions (e.g., catheterizations) at the radial or ulnar artery are intended. Given the limited long-term experience with COVID-19 patients so far, it is unclear if those arterial occlusions will resolve spontaneously, or create long term sequelae, e.g., unavailability of the radial artery for angiography access or unavailability of the radial artery for coronary-bypass grafting in the future. The etiology of these bilateral radial artery occlusions is probably multifactorial, including vascular lesions from previous catheter placements, but likely also include a COVID-19 related hypercoagulatory state. However, the described development of bilateral radial artery occlusion in a relatively young and therapeutically anticoagulated patient with no history of atherosclerosis was unexpected. Venous thrombotic complications are not uncommon in COVID-19 patients. Confirming our findings above, ulnar arterial compression demonstrated that thenar rSO 2 was dependent on ulnar artery flow (Fig. To test for collateral perfusion undetectable by pulse-oximetry, we measured regional oxygen saturation (rSO 2) of the thenar muscle by near-infrared spectroscopy (NIRS). The effect was reversible upon release of the ulnar artery (Fig. This compression caused an immediate loss of the finger’s pulse-oximetry perfusion signal. Thereafter, the ulnar artery at the wrist was compressed. To test collateral arterial supply of the hand, a pulse-oximeter was placed on the index finger. However, Doppler-derived flow-signals could only be obtained from the ulnar arteries (Fig. Sonography showed the typical anatomical localization of both radial and ulnar arteries. Preparing the insertion of a new radial artery catheter (ICU-day 29) for invasive blood pressure measurement and blood sampling, we detected that both radial arteries were non-pulsating and occluded: ICU-treatment included mechanical ventilation and therapeutic anticoagulation. The patient had been admitted with severe hypoxemia and multiple pulmonary emboli were CT-confirmed. In our COVID-19 ICU a 49-year-old male patient was admitted, with past medical history of obesity, smoking and diabetes, but no reported atherosclerotic complications. The described development of bilateral radial artery occlusion in a relatively young and therapeutically anticoagulated patient with no history of atherosclerosis was unexpected. Confirming our findings above, ulnar arterial compression demonstrated that thenar rSO 2 was dependent on ulnar artery flow. (c) To test for collateral perfusion undetectable by pulse-oximetry, we measured regional oxygen saturation (rSO 2) of the thenar muscle by near-infrared spectroscopy (NIRS). The effect was reversible upon release of the ulnar artery. (b) To test collateral arterial supply of the hand, a pulse-oximeter was placed on the index finger. However, Doppler-derived flow-signals could only be obtained from the ulnar arteries. Preparing the insertion of a new radial artery catheter for invasive blood pressure measurement and blood sampling, we detected that both radial arteries were non-pulsating and occluded: (a) Sonography showed the typical anatomical localization of both radial and ulnar arteries. Objective of this case report is to draw attention to a less known thrombotic complication associated with COVID-19, i.e., thrombosis of both radial arteries, with possible (long-term) consequences.
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