Discussion
Since September 2019 during covid 19 pandemic , many cases of thromboembolic events have been reported1, 2.The Prevalence of thrombosis among patients with covid 19 is not fully established , but studies showed that most of them are venous thromboembolism3. Klok et al., study revealed that the cumulative incidence of a composite outcome of vascular events (acute pulmonary embolism, deep-vein thrombosis, ischemic stroke, myocardial infarction, systemic arterial embolism) was 31%, the incidence of venous thromboembolisms was 27%, and the incidence of arterial events was 3.7%, among patients in the ICU5.
In this study we report an ICU admitted covid 19 patient with iliac and infrainguinal arterial thrombosis. Assessment about vasculitis, antiphospholipid antibody syndrome, systemic lupus erythematosus and another common causes of arterial thrombosis were unremarkable. There are several mechanisms which can explain the correlation of covid 19 disease and thromboembolic events. In severe cases of covid 19, cytokines storm and infection of endothelial cells through angiotensin-converting enzyme 2 protein cause endothelial damage , coagulopathy and complement-induced thrombosis , microangiopathy and thromboembolic events6-8. So probably covid 19 can be considered the probable cause of thromboembolism in our patient through these mechanisms.
His study reported a covid 19 patient who developed arterial lower extremity thrombosis leading to acute ischemia and limb amputation. Our case and several reports of thromboembolic events among hospitalized patients of covid19 reveal that health care providers should be aware of life-threatening thromboembolic events associated with covid 19 so that prompt and appropriate intervention can be undertaken.