Introduction COVID-19 is an infectious disease that has been associated not only with respiratory complications. The COVID-19 disease includes, also damage to other organ systems as well as coagulopathy. The present report describes a case of COVID-19 presenting with acute mesenteric ischemia (AMI) and subsequent acute limb ischemia (ALI). Presentation of case An 84-years old hospitalized female patient presenting diabetes and recent COVID-19 reported acute onset of abdominal pain and typical findings of AMI. The CT-angiography confirmed the AMI secondary to a superior mesenteric artery (SMA) occlusion. The patient was managed through an endovascular approach using a SMA mechanical thrombectomy and stenting with a good result. Discussion Treatment of this life-threatening condition includes surgical resection of the necrotic bowel, restoration of blood flow to the ischemic intestine and supportive measure – gastrointestinal decompression, fluid resuscitation, hemodynamic support. Endovascular management of AMI is preferred over the standard surgical approach due to a reduced mortality and morbidity rates. Imaging findings of intestinal necrosis, however, represent an indication for AMI surgical treatment with explorative laparotomy. Different endovascular solutions have been employed to address AMI including mechanical thrombectomy, local thrombolysis, and PTA-stenting. Conclusion COVID-19 clinical presentation can be atypical, including gastrointestinal symptoms. If a first embolic event occurs, an aggressive anticoagulation treatment could be inefficient to reduce the risk of subsequent embolization events. The limited life expectancy of such revascularization procedures should orientate towards less invasive treatments. Highlights • The COVID-19 disease includes damage to other organ systems as well as coagulopathy. • COVID-19 clinical presentation can be atypical, including gastrointestinal symptoms. • Endovascular approach of AMI is preferred due to a reduced mortality. • Few cases of COVID-related AMI have been reported.
【저자키워드】 Case report, COVID 19, Mechanical thrombectomy, Acute mesenteric ischemia, Acute limb ischemia, 【초록키워드】 COVID-19, Treatment, Necrosis, Hospitalized, Mortality, Respiratory complications, risk, Local, surgical, Infectious disease, abdominal pain, COVID-19 disease, Coagulopathy, management, imaging, intestine, morbidity, female, Patient, Ischemia, hemodynamic, gastrointestinal symptoms, Atypical, blood flow, organ system, Support, necrotic, life-threatening, anticoagulation treatment, surgical resection, bowel, presentation, approach, intestinal, limb, include, reported, subsequent, events, reduced, less, reduce, presenting, inefficient, diabete, embolic, invasive treatments, 【제목키워드】 COVID-19, Treatment, peripheral ischemia,