A 60 year old hypertensive male presented to our institution with significant respiratory distress. He was subsequently intubated in the ER due to deteriorating respiratory status and reduced level of consciousness. On day 8 of his ICU course, the left lower limb appeared dusky and mottled up to the mid-thigh (). The right distal forefoot displayed a well demarcated discoloration.\nCT angiography revealed; Infra-renal aortic left sided eccentric, non-calcified atheromatous plaque. Significant occlusion of the left common iliac artery extending to infra-popliteal arteries. A joint decision was made to avoid surgery given the poor prognosis associated with severe acute respiratory distress syndrome and high inotropic support. The patient expired the following morning.
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.