Successful Catheter-directed thrombolysis for acute lower limb ischemia secondary to COVID-19 infection

Muhammad, Kamel; Tantawy, Tamer Ghatwary; Makar, Ragai R.; Olojugba, Oladeji

A 49-year-old man was admitted to his local hospital with left leg pain and breathing difficulties. He had negative nasopharyngeal polymerase-chain-reaction tests for SARS-CoV-2. Chest X-ray and Computed-Tomography Pulmonary Angiogram displayed typical COVID-19 radiological features as ground-glass opacities and bronchovascular thickening. His respiratory symptoms resolved after four days of supportive treatment, while his left leg became more painful and discoloured. He was referred to our centre with acute left leg ischaemia. CT Angiogram revealed eccentric mural thrombus at the aortic bifurcation, extending into left common iliac and an abrupt occlusion of left popliteal, tibioperoneal and posterior tibial arteries. He was treated with Catheter-directed thrombolysis for 48-hours that achieved successful revascularisation of the ischaemic limb with no intervention-related complications. At six-weeks follow-up, he showed full recovery. Our case demonstrates that catheter-directed thrombolysis is a successful and safe treatment option in a COVID-19 patient with acute arterial occlusion.