Association between Peripheral Arterial Thrombosis and COVID-19 using CT Angiography: A Retrospective Observational Study

Abstract

Introduction: Arterial thromboembolism is a major cause of morbidity and mortality in Coronavirus Disease 2019 (COVID-19) patients in both General Inpatient ward and Intensive Care Unit (ICU) settings. As COVID-19 is associated with coagulopathy or vasculopathy, it is necessary to investigate whether the peripheral vessels were also affected due to COVID-19-related thrombosis. Computed Tomography Angiography (CTA) is a quick, accurate, non invasive, and reliable method for assessing the location, extent and severity of arterial thrombosis. Aim: To evaluate the association of acute peripheral arterial thrombosis in patients with COVID-19 infection and assess the differences in peripheral extremity clot burden using peripheral limb CTA. Materials and Methods: A retrospective observational study was conducted in the Department of Radiology, Topiwala National Medical College and B.Y.L. Nair Charitable. Hospital, Mumbai, Maharashtra, India, from April 2020 to April 2021. A total of 70 patients with medical records of acute limb ischaemia, consisting of 35 Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection-positive patients and 35 SARS-CoV-2 negative patients, who underwent peripheral CTA were included in the present study. For calculating arterial clot severity and extent in the peripheral extremities, three different systems were used. Age, sex, symptoms, co-morbidities, and CT thrombus burden score were analysed in both groups. The association between variables was analysed using the Chi-square test. Results: The age range of patients presenting with acute limb ischaemia was 24-74 years (mean age=50 years). Claudication, pain and redness had a significant association with COVID-19 positive patients (p-value <0.001). It was also observed that proximal vessels had a slightly higher preponderance for thrombosis. A significant mean difference in arterial thrombus burden was observed in SARS-CoV-2 infection positive patients, with greater thrombus burden involving proximal vessels. In only the proximal vessels, the overall clot burden was 2.31±3.09 and 0.89±1.25 in the COVID-19 positive and negative groups, respectively (p-value=0.014). COVID-19 infected patients had a predilection for peripheral arterial thrombosis compared to controls, with a significant p-value of 0.034 in proximal upper limb involvement. Conclusion: Computed tomography angiography is the preferred diagnostic modality for the evaluation of arterial thrombosis. Greater clot burden was seen in the proximal vessels of both upper and lower limbs in COVID-19 patients.

Keywords

• clot burden
• computed tomography
• coronavirus disease 2019
• distal predominant
• proximal only
• proximal predominant