cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2021-2885cardiovascular-2885Research ArticleИШЕМИЯ НИЖНИХ КОНЕЧНОСТЕЙСравнительный анализ результатов применения тромбэктомии и консервативного лечения при острой ишемии конечностей у пациентов с COVID-19-ассоциированной пневмониейSurgical thrombectomy versus conservative treatment in cases of acute limb ischemia with COVID-19 pneumoniahttps://orcid.org/0000-0003-2810-2810FahadА. М.FahadA. M.

Department of Cardiovascular Surgery

Эн-Наджаф

Fahad Ahmed Muhi — MD, PhD, Clinical Cardiothoracic & Vascular surgeon, Senior researcher, Department of Cardiovascular Surgery.

Najaf

ayam.mohammad@yahoo.comhttps://orcid.org/0000-0002-3357-4858Al-KhalidiH. А.AlkhalidiH. A.

Faculty of Medicine

Эн-Наджаф

Al-Khalidi Hasanain A. — MD, PhD, Clinical Neurologist, Leading researcher, Faculty of Medicine.

Najaf

medicalresearch79@yahoo.comhttps://orcid.org/0000-0003-3748-681XAltimimiY. Q. M.AltimimiY. Q. M.

Майсан

Altimimi Yasir Qays Majeed — MD, PhD, Clinical Cardiothoracic & Vascular surgeon, researcher.

Misan

medicalresearch11@yahoo.comNajaf Health Directorate, Al-Sadder Teaching Medical CityИракNajaf Health Directorate, AlSadder Teaching Medical CityIraqKufa University; Middle Euphrates Neurosciences CenterИракKufa university, Middle Euphrates Neurosciences CenterIraqCardiothoracic and Vascular Surgery Department, Al-Sadder Teaching HospitalИракCardiothoracic and Vascular Surgery Department, Al-Sadder Teaching HospitalIraq20211507202120428852885Copyright © Fahad А.М., Al-Khalidi H.А., Altimimi Y.Q., 20212021Fahad А.М., Al-Khalidi H.А., Altimimi Y.Q.Fahad A.M., Alkhalidi H.A., Altimimi Y.Q.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2885

На сегодняшний день, инфекция COVID-19 является одной из главных причин развития острого респираторного дистресс-синдрома, полиорганной недостаточности, коагулопатии и внутрисосудистого тромбоза. Следовательно, это основной причинный фактор формирования острой ишемии конечностей.

Цель

Цель. В ходе одноцентового исследования сравнить результаты лечения пациентов с ишемией конечностей и сопутствующей инфекцией COVID-19.

Материал и методы

Материал и методы. В настоящее исследование было включено 26 пациентов, которые были разделены на две группы: первая группа (n=14) — пациенты, подвергнутые консервативному лечению; вторая группа (n=12) — пациенты, перенесшие хирургическую лечение — тромбэктомию. Результаты лечения были оценены через 24 часа и 30 дней.

Результаты

Результаты. Консервативное лечение оказалось эффективным в 85,72% случаев, тогда как тромбэктомия — в 75%. В каждой группе было зарегистрировано две ампутации ниже коленного сустава. Кроме того, в каждой группе произошли 3 летальных исхода.

Заключение

Заключение. По результатам исследования, как консервативное лечение, так и тромбэктомия имеют сопоставимую эффективность при острой ишемии конечностей у пациентов с COVID-19.

COVID-19 infection is a major cause for acute respiratory distress syndrome, multi-organ dysfunction, coagulopathy, and intravascular thrombosis; therefore, it is the main causative factor for acute limb ischemia.

Aim

Aim. To compare the treatment outcome of two limb ischemic groups post COVID-19 infection in a single center and detect at least which is better for the patients in the period of COVID-19 pandemic.

Material and methods

Material and methods. Here, in this study, we collect 26 patients and divided them into two groups, G1 (14) patients treated conservatively and G2 (12) patients treated with surgical thrombectomy. Data were analyzed to look for the outcome of groups after 24 hours and 30 days.

Results

Results. The successful rate of conservative treatment was 85,72% in G1, while it was 75% in G2. There were two amputations below the knee joint in each group. Three patients died in both groups.

Conclusion

Conclusion. In conclusion, both conservative treatment and surgical thrombectomy have a comparable successful rate in the selected group of COVID-19 patients.

COVID-19ишемия конечностейтромбэктомияпневмониякоагулопатияCOVID-19 infection is a major cause for acute respiratory distress syndromemulti-organ dysfunctioncoagulopathyand intravascular thrombosisthereforeit is the main causative factor for acute limb ischemia. Aim. To compare the treatment outcome of two limb ischemic groups post COVID-19 infection in a single center and detect at least which is better for the patients in the period of COVID-19 pandemic. Material and methods. Herein this studywe collect 26 patients and divided them into two groupsG1 (14) patients treated conservatively and G2 (12) patients treated with surgical thrombectomy. Data were analyzed to look for the outcome of groups after 24 hours and 30 days. Results. The successful rate of conservative treatment was 8572% in G1while it was 75% in G2. There were two amputations below the knee joint in each group. Three patients died in both groups. Conclusion. In conclusionboth conservative treatment and surgical thrombectomy have a comparable successful rate in the selected group of COVID-19 patients.ReferencesAl-Khalidi H, Hassoun H, Aljid Z, Allebban Z. COVID-19 Related Spinal Subdural Hematoma Presented with Acute Compressive Myelopathy. Authorea. Preprint;12, 2020. doi:10.22541/au.160516630.00713824/v1.Al-Khalidi H, Hassoun H, Aljid Z, Allebban Z. COVID-19 Related Spinal Subdural Hematoma Presented with Acute Compressive Myelopathy. Authorea. Preprint;12, 2020. doi:10.22541/au.160516630.00713824/v1.Anwar S, Acharya S, Shabih S, Khabut A. Acute Limb Ischemia in COVID-19 Disease: A Mysterious Coagulopathy. Cureus. 2020;12(7):e9167. doi:10.7759/cureus.9167.Anwar S, Acharya S, Shabih S, Khabut A. Acute Limb Ischemia in COVID-19 Disease: A Mysterious Coagulopathy. Cureus. 2020;12(7):e9167. doi:10.7759/cureus.9167.Fahad AM, Mohammad AA, Al-Khalidi HA, et al. Case Report: COVID-19 in a female patient who presented with acute lower limb ischemia [version 1; peer review: awaiting peer review] F1000 Research. 2020;9:778. doi:10.12688/f1000research.25319.1.Fahad AM, Mohammad AA, Al-Khalidi HA, et al. Case Report: COVID-19 in a female patient who presented with acute lower limb ischemia [version 1; peer review: awaiting peer review] F1000 Research. 2020;9:778. doi:10.12688/f1000research.25319.1.Singh B, Kaur P, Ajdir N, et al. Covid-19 Presenting as Acute Limb Ischemia. Cureus. 2020;12(7):e9344. doi:10.7759/cureus.9344.Singh B, Kaur P, Ajdir N, et al. Covid-19 Presenting as Acute Limb Ischemia. Cureus. 2020;12(7):e9344. doi:10.7759/cureus.9344.Miesbach W, Makris M. COVID-19. Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clin Appl Thromb Hemost. 2020;26:1076029620938149. doi:10.1177/1076029620938149.Miesbach W, Makris M. COVID-19. Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clin Appl Thromb Hemost. 2020;26:1076029620938149. doi:10.1177/1076029620938149.Bellosta R, Luzzani L, Natalini G, et al. Acute limb ischemia in patients with COVID-19 pneumonia. J Vasc Surg. 2020;72(6):1864-72. doi:10.1016/j.jvs.2020.04.483.Bellosta R, Luzzani L, Natalini G, et al. Acute limb ischemia in patients with COVID-19 pneumonia. J Vasc Surg. 2020;72(6):1864-72. doi:10.1016/j.jvs.2020.04.483.Yu B, Li X, Chen J, et al. Evaluation of variation in D-dimer levels among COVID-19 and bacterial pneumonia: a retrospective analysis. J Thromb Thrombolysis. 2020;50(3):548-57. doi:10.1007/s11239-020-02171-y.Yu B, Li X, Chen J, et al. Evaluation of variation in D-dimer levels among COVID-19 and bacterial pneumonia: a retrospective analysis. J Thromb Thrombolysis. 2020;50(3):548-57. doi:10.1007/s11239-020-02171-y.Gu SX, Tyagi T, Jain K, et al. Thrombocytopathy and endotheliopathy: crucial contributors to COVID-19 thromboinflammation [published online ahead of print, 2020 Nov 19]. Nat Rev Cardiol. 2020;1-16. doi:10.1038/s41569-020-00469-1.Gu SX, Tyagi T, Jain K, et al. Thrombocytopathy and endotheliopathy: crucial contributors to COVID-19 thromboinflammation [published online ahead of print, 2020 Nov 19]. Nat Rev Cardiol. 2020;1-16. doi:10.1038/s41569-020-00469-1.O’Connell JB, Quiñones-Baldrich WJ. Proper evaluation and management of acute embolic versus thrombotic limb ischemia. Semin Vasc Surg. 2009;22:10-6. doi:10.1053/j.semvascsurg.2008.12.004.O’Connell JB, Quiñones-Baldrich WJ. Proper evaluation and management of acute embolic versus thrombotic limb ischemia. Semin Vasc Surg. 2009;22:10-6. doi:10.1053/j.semvascsurg.2008.12.004.Deitcher SR, Carman TL, Sheikh MA, Gomes M. Hypercoagulable syndromes: evaluation and management strategies for acute limb ischemia. Semin Vasc Surg. 2001;14:74-85. doi:10.1053/svas.2001.23156.Deitcher SR, Carman TL, Sheikh MA, Gomes M. Hypercoagulable syndromes: evaluation and management strategies for acute limb ischemia. Semin Vasc Surg. 2001;14:74-85. doi:10.1053/svas.2001.23156.Olinic DM, Stanek A, Tătaru DA, et al. Acute Limb Ischemia: An Update on Diagnosis and Management. J Clin Med.2019;8(8):1215. doi:10.3390/jcm8081215.Olinic DM, Stanek A, Tătaru DA, et al. Acute Limb Ischemia: An Update on Diagnosis and Management. J Clin Med.2019;8(8):1215. doi:10.3390/jcm8081215.Walker TG. Acute Limb Ischemia. Techniques in Vascular and Interventional Radiology, 2009;12(2):117-29. doi:10.1053/j.tvir.2009.08.005.Walker TG. Acute Limb Ischemia. Techniques in Vascular and Interventional Radiology, 2009;12(2):117-29. doi:10.1053/j.tvir.2009.08.005.Fahad AM, Mohammad AA, Al-Khalidi HA, Alshewered AS. Spontaneous pneumothorax as a complication in COVID-19 male patient: A case report. Clin Case Rep. 2020;8(12):3116-9. doi:10.1002/ccr3.3378.Fahad AM, Mohammad AA, Al-Khalidi HA, Alshewered AS. Spontaneous pneumothorax as a complication in COVID-19 male patient: A case report. Clin Case Rep. 2020;8(12):3116-9. doi:10.1002/ccr3.3378.Fahad AM, Al-Khalidi HA, Abdulhameed YA, et al. Pleural effusion in a patient with COVID-19 pneumonia and lung cancer: a case report. Respiratory medicine case report. 2020;31:101302. doi:10.1016/j.rmcr.2020.101302.Fahad AM, Al-Khalidi HA, Abdulhameed YA, et al. Pleural effusion in a patient with COVID-19 pneumonia and lung cancer: a case report. Respiratory medicine case report. 2020;31:101302. doi:10.1016/j.rmcr.2020.101302.Abou-Ismail MY, Diamond A, Kapoor S, et al. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thromb Res. 2020;194:101-15. doi:10.1016/j.thromres.2020.06.029.Abou-Ismail MY, Diamond A, Kapoor S, et al. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thromb Res. 2020;194:101-15. doi:10.1016/j.thromres.2020.06.029.Lodigiani C, Iapichino G, Carenzo L, et al.; Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9-14. doi:10.1016/j.thromres.2020.04.024.Lodigiani C, Iapichino G, Carenzo L, et al.; Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9-14. doi:10.1016/j.thromres.2020.04.024.Acar RD, Sahin M, Kirma C. One of the most urgent vascular circumstances: Acute limb ischemia. SAGE Open Med. 2013;11;1:2050312113516110. doi:10.1177/2050312113516110.Acar RD, Sahin M, Kirma C. One of the most urgent vascular circumstances: Acute limb ischemia. SAGE Open Med. 2013;11;1:2050312113516110. doi:10.1177/2050312113516110.Enezate TH, Omran J, Mahmud E, et al. Endovascular versus surgical treatment for acute limb ischemia: A systematic review and meta-analysis of clinical trials. Cardiovasc Diagn Ther. 2017;7:264-71. doi:10.21037/cdt.2017.03.03.Enezate TH, Omran J, Mahmud E, et al. Endovascular versus surgical treatment for acute limb ischemia: A systematic review and meta-analysis of clinical trials. Cardiovasc Diagn Ther. 2017;7:264-71. doi:10.21037/cdt.2017.03.03.Perini P, Nabulsi B, Massoni CB, et al. Acute limb ischemia in two young, non-atherosclerotic patients with COVID-19. The Lancet. 2020;395(10236):1546. doi:10.1016%2FS0140-6736(20)31051-5.Perini P, Nabulsi B, Massoni CB, et al. Acute limb ischemia in two young, non-atherosclerotic patients with COVID-19. The Lancet. 2020;395(10236):1546. doi:10.1016%2FS0140-6736(20)31051-5.Gubitosa JC, Xu P, Ahmed A, Pergament K. COVID-19-Associated Acute Limb Ischemia in a Patient on Therapeutic Anticoagulation. Cureus. 2020;12(9):e10655. doi:10.7759/cureus.10655.Gubitosa JC, Xu P, Ahmed A, Pergament K. COVID-19-Associated Acute Limb Ischemia in a Patient on Therapeutic Anticoagulation. Cureus. 2020;12(9):e10655. doi:10.7759/cureus.10655.Линец Ю. П., Артюхов С. В., Казанцев А. Н. и др. Тромбозы в структуре хирургических осложнений COVID-19. Скорая медицинская помощь. 2020;21(4):24-9. doi:10.24884/2072-6716-2020-21-4-24-29.Linets YuP, Artyukhov SV, Kazantsev AN, et al. Thrombosis in the structure of surgical complications of COVID-19. Emergency. 2020;21(4):24-9. (In Russ.) doi:10.24884/2072-6716-2020-21-4-24-29.Сафиуллина С. И., Литвинов Р. И. Рекомендации по профилактике и коррекции тромботических осложнений при COVID-19. Казанский медицинский журнал. 2020;101(4):485-8. doi:10.17816/KMJ2020-485.Safiullina SI, Litvinov RI. Recommendations for the prevention and correction of thrombotic complications in COVID-19. Kazan Medical Journal. 2020;101(4):485-8. (In Russ.) doi:10.17816/KMJ2020-485.

The authors declare that there are no conflicts of interest present.