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 ().
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.