COVID-19-ASSOCIATED ACUTE LOWER LIMBS ISCHAEMIA IN ELDERLY AND SENILE PATIENTS: TREATMENT PROSPECTS (PRELIMINARY ANNOUNCEMENT)

  • О. E. Kanikovsky
  • S. V. Sander
  • О. I. Bondarchuk
  • О. P. Fedzhaha
  • V. P. Malyarchuk
  • V. V. Mosendz
Keywords: acute lower limbs ischemia, COVID-19.

Abstract

Summery. The aim — analysis of preliminary experience of treatment of COVID-19-associated acute lower limbs ischemia in elderly and senile patients.

Materials and methods. We examined 48 patients (age 60- 84 years). First group — 16 patients with COVID-19-associated acute lower limbs ischemia, second group — 32 patients with chronic limb ischemia without coronavirus infection. .

Results and discussion. First group’s patients had extended blood clotting time (more than 13-15 min). Other blood clotting indicators changed slightly. An isoline or a low-amplitude curve was recorded during photoplethysmography. After thrombectomy (6 patients) 3 patients had fatal thrombotic complications (PE, myocardial infarction, stroke), 1 had progressive ischemia. Pharmacotherapy was performed in 10 patients (in 2 patients later than 12 hours from the onset of ischemia). The effectiveness of timely started pharmacotherapy reached 67 %. All patients of group II had arteriosclerosis of the tibial arteries. Blood clotting indicators were normal. A high-amplitude curve was recorded during photoplethysmography. Thus, all elderly and senile patients has arteriosclerosis of the tibial arteries. On this basis, there was a fatal coincidence (coagulopathy, a sharp slowdown in blood flow, endothelial dysfunction) in case of coronavirus infection (COVID-19). Prospects for further developments are the improvement of anticoagulant therapy (for example, the simultaneous use of unfractionated and low molecular weight heparin) and improving of collateral circulation (for example, nerve block and forced intraarterial infusion or lavage).

Conclusion. Currently, the effectiveness of thrombectomy in elderly and senile patients with COVID-19-associated acute lower limbs ischemiа is 33 %, the effectiveness of timely started pharmacotherapy Is 67 %.

References

1. Trykhlib VI. Uskladnennia u khvorykh na COVID-19. Infektsiini khvoroby. 2020;1(99):37-46.
2. Nanshan Chen, Min Zhou, Xuan Dong ,Jieming Qu, Fengyun Gong, Yang Han, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–13. DOI:10.1016/S0140-6736(20)30211-7.
3. Aboyans V, Ricco J-B, Bartelink M-L EL, Björck M, Brodmann M, Cohnert T, et al. Editor’s Choice e 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55:305-368. DOI:10.1016/j.ejvs.2017.07.018
4. Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, et al. Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia. Eur J Vasc Endovasc Surg. 2019;58(1):S1-S109. DOI: 10.1016/j. ejvs.2019.05.006.
5. Lobastov KV, Schastlivcev IV, Porembskaja OJa, Dzhenina OV, Bargandzhija AB, Caplin SN. COVID-19-associirovannaja koagulopatija: obzor sovremennyh rekomendacij po diagnostike, lecheniju i profilaktike. Stacionarozameshhajushhie tehnologii: Ambulatornaja hirurgija. 2020;(3-4):36-51. DOI: 10.21518/1995-1477-2020-3-4.
6. Malikov MH. COVID-19 i ego oslozhnenija v sosudistoj hirurgii. Tadzhikskij derzhavnij medichnij unіversitet іm. Abualі іbnі Sіno. [onovleno 2020 grud. 23]. Dostupno na: https://tajmedun.tj/ru/novosti/nauka-i-innovatsiya/covid- 19-i-ego-oslozhnenie-v-sosudistoy-khirurgii4583653456/
7. Avila J., Long B., Holladay D., Gottlieb M. Thrombotic complications of COVID-19. Am J Emerg Med. 2021 Jan;39:213-218. DOI: 10.1016/j.ajem.2020.09.065
8. Kompendіum. Dovіdnik lіkars’kih preparatіv. [Іnternet]. Dostupno na: https://compendium.com.ua/uk/
9. Sander SV. Mozhlivostі forsovanogo vnutrіshn’oarte-rіal’nogo vvedennja lіkars’kih zasobіv u kompleksі lіku-vannja hronіchnoї іshemії tkanin nizhnіh kіncіvok. Klіnіchna hіrurgіja. 2017;2:62-5.
10. Sander SV. Parcіal’na denervacіja v kompleksnomu lіkuvannі okljuzіjnih zahvorjuvan’ arterіj nizhnіh kіncіvok. Klіnіchna hіrurgіja. 2011;3:45-8.
Published
2021-06-20
How to Cite
KanikovskyО. E., Sander, S. V., BondarchukО. I., FedzhahaО. P., Malyarchuk, V. P., & Mosendz, V. V. (2021). COVID-19-ASSOCIATED ACUTE LOWER LIMBS ISCHAEMIA IN ELDERLY AND SENILE PATIENTS: TREATMENT PROSPECTS (PRELIMINARY ANNOUNCEMENT). Kharkiv Surgical School, (2), 11-16. https://doi.org/10.37699/2308-7005.2.2021.02
Section
ORIGINAL RESEARCHES