COVID-19 Infection-Related Limb Loss and Mortality in Acute Limb Ischemia

Female doctor talking with patient along coworker in ICU. Man is lying on bed amidst essential workers. Healthcare workers are in protective workwear.
Investigators sought to determine the relationship between COVID-19 infection in patients with acute limb ischemia and limb salvage estimates.

Patients with acute limb ischemia and COVID-19 infection have increased rates of limb loss and mortality compared with non-COVID-19 patients with acute limb ischemia, according to study findings published in Annals of Vascular Surgery.

Researchers aimed to evaluate the impact of COVID-19 infection on amputation and death in patients with acute limb ischemia. The primary outcome was the limb salvage rate and overall mortality. Secondary outcomes included factors related to overall mortality and factors related to limb loss.

The researchers conducted a prospective consecutive cohort study between January 2020 and October 2021 at the Vascular and Endovascular Surgery Service of the Hospital do Servidor Publico Estadual de São Paulo in Brazil. The study included 23 patients with acute limb ischemia and COVID-19 infection, and 49 patients with acute limb ischemia and no COVID-19 infection. Atrial thrombosis was the main cause of acute limb ischemia with no differences between cohorts. Patient profiles of both cohorts were similar for age, sex, and comorbidities except for greater prevalence of arrhythmias in the non-COVID-19 cohort. D-dimer and creatinophosphokinase rates were higher in the COVID-19 cohort.

Overall mortality rate is 20.8% and higher in the COVID-19 cohort (30.4%) vs non-COVID-19 cohort (16.7%) (P =.04). The limb salvage rate overall at 30 days is 79.1% and better in the non-COVID-19 cohort (89.7%) vs COVID-19 cohort (60.8%) (P =.01). Univariate and multivariate logistic regression analysis shows the following factors related to overall mortality in patients with acute limb ischemia:

  • D-dimer concentration of greater than1000mg/dL (hazard ratio [HR] 2.28; 95% CI, 1.94-6.52; P =.038)
  • COVID-19 infection (HR 1.8; 95% CI, 1.01-4.01; P =.018)
  • Pharmacomechanical thrombectomy with greater than150 cycles (HR 2.01; 95% CI, 1.005-6.781; P =.002).

Regression analysis also shows factors related to limb loss, including D-dimer concentration of greater than 1000 mg/mL (HR 3.76; 95% CI, 1.85-5.89; P =.027) and COVID-19 infection (HR 1.38; 95% CI, 1.03-4.75; P =.035).

Underpowered sample size and lack of randomization represent the main limitations of this study.

“COVID-19 has a worse prognosis among patients with [acute limb ischemia], with higher rates of limb loss and overall mortality relative to non-COVID-19 patients,” the study authors wrote.


de Athayde Soares R, Futigami AY, Barbosa AG, Sacilotto R. Acute arterial occlusions in COVID-19 times: a comparison study among patients with acute limb ischemia with or without COVID-19 infection. Ann Vasc Surg. Published online April 19, 2022. doi:10.1016/j.avsg.2022.04.006

This article originally appeared on The Cardiology Advisor