Long-term results of various revascularization methods in acute limb ischemia in patients with COVID-19

Introduction. Acute limb ischemia in patients with COVID-19 is a serious complication with a high risk of limb loss and mortality. Despite the growing number of studies devoted to this problem, there is no consensus on the optimal revascularization strategy. The purpose of this study was to compare the long-term results of open and endovascular interventions in patients with acute limb ischemia in acute stage of COVID-19.

Methods. Study included 257 patients with acute limb ischemia IIA-IIB class Rutherford, hospitalized in the period from 01.01.2018 to 20.06.2023. The patients were divided into four groups: I (n=50) and II (n=50) – controls without COVID-19; III (n=86) and IV (n=71) – with COVID-19. Open revascularization was performed in groups I and III, and endovascular revascularization with catheter-directed selective thrombolysis was performed in groups II and IV. Patency of the reconstructed arteries was assessed 6–12 months after surgery using ultrasound and CT angiography.

Results. The incidence of late retrombosis was 41,3 % in the open revascularization groups and 33,3 % in the endovascular treatment groups. In patients with COVID-19, after open surgery, recurrence of acute limb ischemia was observed 2 times more often (8,7 % vs. 4,4 %), but the overall frequency of retrombosis was comparable. The development of stage III-IV chronic ischemia (Rutherford) was more typical for patients after open interventions (17,6 % vs. 7,3 %).

Conclusions. Endovascular revascularization with catheter-directed selective thrombolysis for acute ischemia in patients with COVID-19 is associated with a lower incidence of recurrent acute ischemia and the development of chronic arterial insufficiency in the long term compared to open surgery and is the optimal revascularization strategy in this group of patients.

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