1General Surgery Resident, Oman Medical Specialty Board(OMSB), Muscat
2Medical Officer, Division of General Surgery, Sultan Qaboos University Hospital, Muscat
3Consultant, Department of Anesthesia, Sultan Qaboos University Hospital, Muscat, Oman
4Vascular surgery unit, Division of Surgery, Sultan Qaboos University Hospital, Muscat, Oman
Purpose: The COVID 19 pandemic has an association with coagulopathy the reason for which is still under investigation. During the first wave, centers internationally saw more of venous thromboembolism and during the second wave there was a rise in acute limb ischemia. In this paper we analyze our experience with acute limb ischemia patients who were managed at our tertiary Centre in Muscat, Oman during the first and second waves of the pandemic.
Methods: The paper is a observational cohort study based on a single tertiary center, in which data was collected prospectively from the electronic medical records of COVID 19 positive patients who were referred to the vascular surgery unit, during the period of March 2020 to August 2021, the mentioned period involves both the first and second wave spikes of COVID – 19 in Oman. The records were analyzed to assess patient’s demographic data (Age and gender) as well as their co morbidities, current medications and other risk factors including smoking or previous amputations. This study has been approved by the ethics committee of our university hospital.
Results: The study had a total of 15 patients of which 10 were male with a range of 38 – 96 years. None of the patients were vaccinated. All had at least 1 co morbidity and 10 were in the COVID intensive care unit. All the patients were on prophylactic enoxaparin at time of referral and had elevated inflammatory markers. Our results show a significant rise in acute limb ischemia during the 2nd wave with 9 of those patients being referred at the above-mentioned time.
Conclusion: COVID-19 is strongly associated with an increased incidence of thromboembolic events, secondary to the hypercoagulable state. Our statistics also show the significant increase of ALI occurrence in the second wave of COVID 19 at our center in comparison to the first wave. Managing ALI remains a challenge considering the persistent hypercoagulable state produced by the infection in this subset of patients who are critically ill. Outcomes remain bleak with patients either succumbing to the infection or requiring an amputation.
COVID – 19, a virus which has resulted in a global pandemic, mainly presenting with respiratory symptoms was also found to have a close association with coagulopathies resulting in severe life-threatening complications such as disseminated intervascular coagulation and acute limb ischemia. The aim of the following study is to recognize the clinical findings and the characteristics of patients infected with COVID – 19 who presented with Acute Limb ischemia at Sultan Qaboos Hospital University Hospital. Furthermore, we are analyzing the statistical differences in the occurrence of ALI during the first and second waves of COVID 19 at the Sultanate of Oman.
The following paper also involves the management of those patients, especially after being referred to the Vascular surgery team in the respective mentioned center.
Acute limb ischemia; COVID – 19; Pandemic; Coagulopathy; Thrombosis; First wave; Second wave; Management; Outcome
Ola Al Hamdani, Dana Al Baali, Serina Ruth Salins, Edwin Stephen, Ibrahim Abdelhady, Hanan Al Mawaali, Khalifa Al Wahaibi. Experience in Management of Acute Limb Ischemia During The Covid – 19 Pandemic From A Tertiary Centre in Oman. Int Case Rep Jour. 2022;2(1):1-4