Vascular Manifestations of COVID-19

The novel coronavirus (COVID-19) continues to wreak havoc around the world, with 88 million confirmed cases and more than 2 million deaths as of January 8, 2021. In the United States, the number of infections has risen dramatically since the first week of March, and the US now has more confirmed cases and deaths than any other country worldwide. These are sobering numbers. What is still unrecognized is the large burden of vascular complications associated in the short and long-term with this disease.

COVID-19 causes blood to thicken and become more prone to clotting. Unsurprisingly, a significant proportion of patients affected with this disease show a high incidence of deep venous thrombosis, even when they are on some form of blood thinners. If these blood clots travel to the lungs, a fatal condition known as pulmonary embolism can occur. Also, some patients may see an increase in the incidence of peripheral arterial disease which causes the blood circulation to legs (or, sometimes arms) to be cut off completely. Even if treated aggressively by surgical means, outcomes have been poor, leading to limb loss.

Rarely, for some patients affected by COVID-19, limb-threatening ischemia (circulation inadequacy) has been noted as the only complaint. Few, but significant, incidences of strokes affecting young patients have been reported too. Prevention, wherever possible, by taking some form of blood-thinning agent during and after the COVID pneumonia illness remains the key.

Yet another increasingly recognized effect on the population has been a sharp drop in the number of emergency and urgent surgeries being performed for the treatment of life and limb-threatening conditions like abdominal aortic aneurysm, carotid artery stenosis and peripheral arterial disease. This is likely due to patients avoiding timely medical attention owing to the fear of contracting COVID-19 in the hospital or out-patient setting. Delaying care or waiting until the COVID situation gets better may result in worse problems than COVID is causing. Patients presenting in advanced and late stages of such diseases have very poor outcomes even when surgical treatment is utilized.

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