A review of acute limb ischemia in COVID-positive patients

UMMS Affiliation

Department of Surgery, Division of Vascular Surgery

Publication Date


Document Type



Cardiovascular Diseases | Infectious Disease | Pathological Conditions, Signs and Symptoms | Surgery | Virus Diseases


This literature review discusses the current evidence on acute limb ischemia (ALI) in patients with COVID-19. Throughout the pandemic, these patients have been at increased risk of arterial thrombotic events and subsequent mortality as a result of a hypercoagulable state. The exact mechanism of thrombosis is unknown; however arterial thrombosis may be due to invasion of endothelial cells via angiotensin-converting enzyme 2 (ACE2) receptors, endothelial injury from inflammation, or even free-floating aortic thrombus. Multiple studies have been performed evaluating the medical and surgical management of these patients; the decision to proceed with operative intervention is dependent on the patient's clinical status as it relates to COVID-19 and morbidity of that disease. The interventions afforded typically include anticoagulation in patients undergoing palliation; alternatively, thrombectomy (endovascular and open) is utilized in other patients. There is a high risk of rethrombosis, despite anticoagulation, given persistent endothelial injury from the virus. Postoperative mortality can be high in these patients.


acute limb ischemia, COVID-19, thrombosis

DOI of Published Version



Ilonzo N, Judelson D, Al-Jundi W, Etkin Y, O'Banion LA, Rivera A, Tinelli G, Bellosta R, Vouyouka A. A review of acute limb ischemia in COVID-positive patients. Semin Vasc Surg. 2021 Jun;34(2):8-12. doi: 10.1053/j.semvascsurg.2021.04.004. Epub 2021 May 20. PMID: 34144749; PMCID: PMC8167656. Link to article on publisher's site

Journal/Book/Conference Title

Seminars in vascular surgery

Related Resources

Link to Article in PubMed

PubMed ID