A 48 year old male with a history of asthma presented to our institution with a cough, shortness of breath and a fever. The patient subsequently tested positive for Covid-19 and was intubated and admitted to the ICU with hypoxic respiratory failure after failure to improve with initial therapy. The patient was started on therapeutic enoxaparin treatment.\nOn the 10th day the patient was on high ventilator settings and minimal inotropic support. On examination, lower limbs showed unsalvageable ischemia with no palpable pulses (). Urgent CT angiography revealed complete occlusion of the left arterial tree from the aortic bifurcation descending down to the infra-popliteal arteries. Contralaterally, distal occlusion of the superficial femoral artery down to the infra-popliteal arteries. CT of the lung displayed ground glass appearance of the lungs associated with consolidation. After consulting the next of kin and the risk; benefit of proceeding to surgery. The joint decision to provide supportive care was made. The patient was declared dead on the same day.
A 58 year old previously healthy male who presented to us after being diagnosed with Covid-19 pneumonia. On arrival the patient was displaying signs of severe respiratory distress with exhaustion. He was immediately intubated and transferred to the ICU. During his stay he was on high ventilatory and inotropic support. On day 11, all distal extremities showed non salvageable ischemia with no palpable distal pulses (). Urgent CT angiography revealed extensive thrombosis affecting aortic bifurcation and bilateral iliac systems. Despite aggressive anticoagulation the patient subsequently expired secondary to refractory shock. The patient was anti-coagulated for the entire duration of his hospital stay ().