Acute Limb Ischemia due to Arterial Thrombosis in a Patient with COVID-19 Pneumonia: A Case Report

Renata Primasari, Yetti Hernaningsih, Hartono Kahar, Bramantono Bramantono


The COVID-19 pandemic has caused more than 4 million deaths worldwide to date. During the course of the COVID-19 pandemic, thrombotic complications due to hypercoagulable state have emerged as an important issue. Acute limb ischemia is one of emergency cases in vascular disease caused by a sudden decrease in arterial limbs perfusion. Here, we report a 53-year-old male patient with severe COVID-19 and a history of uncontrolled type 2 diabetes mellitus (T2DM) who developed extensive arterial thrombosis and limb ischemia despite being on therapeutic-dose anticoagulation, requiring surgical intervention. Right and left leg open thrombectomy was performed at day 7 after admission due to the excruciating pain and the worsening of the limb conditions. The patient was transferred to intensive care unit in emergency room because of the unstable hemodynamic and passed away a few hours after the surgery. For critically ill patients with COVID-19, special attention should be paid to abnormal coagulation dysfunction and microcirculatory disorders.


acute limb ischemia; ALI; COVID-19; hypercoagulable state


John Hopkins University and Medicine. Johns Hopkins Coronavirus Resource Center - COVID-19 data in motion [Internet]. 2021. Available from:

Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020;7(6):e438–40.

Aboyans V, Ricco JB, Bartelink MLEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763–816.

Nowroozpoor A, Bank MA, Jafari D. Limb ischemia due to extensive arterial thrombosis in the absence of venous occlusion as an unusual complication of critical illness from COVID-19. Case Reports Acute Med. 2021;4(1):23–31.

Dias LM, Martins J, Castro R, Mesquita A. Multiple arterial thrombosis in a patient with COVID-19. BMJ Case Rep. 2021;14(6):2–3.

McNally MM, Univers J. Acute limb ischemia. Surg Clin North Am. 2018;98(5):1081–96.

Yu HH, Qin C, Chen M, Wang W, Tian DS. D-dimer level is associated with the severity of COVID-19. Thromb Res [Internet]. 2020;195(April):219–25. Available from:

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–62. Available from:

Zhou Y, Fu B, Zheng X, Wang D, Zhao C. Severe pulmonary syndrome patients of a new Coronavirus. bioRxiv Prepr. 2020;(February). Available from:

Calvisi SL, Ramirez GA, Scavini M, et al. Thromboembolism risk is higher among patients with diabetes and COVID-19 and is associated to poor clinical outcome. medRxiv. 2021;2021.04.17.21255540. Available from:

Kichloo A, Dettloff K, Aljadah M, et al. COVID-19 and hypercoagulability: A review. Clin Appl Thromb. 2020;26.

Olinic D-M, Stanek A, Tătaru D-A, Homorodean C, Olinic M. Acute limb ischemia: An update on diagnosis and management. J Clin Med. 2019;8(8):1215.

Björck M, Earnshaw JJ, Acosta S, et al. Editor’s choice – European Society for Vascular Surgery (ESVS) 2020 Clinical practice guidelines on the management of acute limb ischaemia. Eur J Vasc Endovasc Surg. 2020;59(2):173–218. Available from:

Lind B, Morcos O, Ferral H, et al. Endovascular strategies in the management of acute limb ischemia. Vasc Spec Int. 2019;35(1):4–9.

Wang J, Chen K, Li X, et al. Postoperative adverse events in patients with diabetes undergoing orthopedic and general surgery. Med (United States). 2019;98(14):1–7.

Pozzobon FM, Perazzo H, Bozza FA, Rodrigues RS, de Mello Perez R, Chindamo MC. Liver injury predicts overall mortality in severe COVID-19: a prospective multicenter study in Brazil. Hepatol Int. 2021;15(2):493–501. Available from:

Taramasso L, Vena A, Bovis F, et al. Higher mortality and intensive care unit admissions in COVID-19 patients with liver enzyme elevations. Microorganisms. 2020;8(12):1–12.

Boregowda U, Aloysius MM, Perisetti A, Gajendran M, Bansal P, Goyal H. Serum activity of liver enzymes is associated with higher mortality in COVID-19: A systematic review and meta-analysis. Front Med. 2020;7(July):1–10.

Wang T, Fontenot RD, Soni MG, Bucci TJ, Mehendale HM. Enhanced hepatotoxicity and toxic outcome of thioacetamide in streptozotocin-induced diabetic rats. Toxicol Appl Pharmacol. 2000;166(2):92–100.

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