CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 AFRICA 115 19 infection by diffuse bilateral consolidation and peripheral ground-glass opacification, as shown in Fig. 2. In addition, computed tomographic angiography revealed an acute thrombotic occlusion of the thoraco-abdominal and infrarenal aorta, extending into the bilaterally common iliac arteries, as shown in Figs 3 and 4. In the examination of the aorto-iliac segments, no calcified atherosclerotic load or stenotic diseases were found in the lumen. The polymerase chain reaction test result was positive. The patient was then taken to the cardiovascular surgery intensive care unit to receive pressurised oxygen therapy support by performing intensive breathing exercises. Furthermore, the treatment protocol for COVID-19 used in our hospital was started immediately, including heparin (enoxaparin 6000), an antiviral (Favipiravir 200 mg), hydroxychloroquine (200 mg 1 × 1), ascorbic acid (1 000 mg) and steroid therapies (methylprednisolone 80 mg 1 × 1). Bilateral femoral embolectomy was decided to correct the bilateral ischaemic condition of the lower extremities. Under local anaesthesia, the patient was taken to a private COVID-19 operating room to undergo aortofemoral embolectomy on the bilateral femoral arteries. Abundant thrombus material was removed from the aorta, and iliac and femoral arteries (Fig. 5). Postoperative distal pulses became prominent, and the lower limbs improved in colour and warmed postoperatively. On postoperative day one, the patient’s oxygen saturation values started to decrease to < 80%. His shortness of breath increased, so he was intubated. While receiving ventilator support, he died of cardiac arrest on the fourth postoperative day. Discussion COVID-19 has high morbidity and mortality rates, especially in elderly patients and those with co-morbidities. Approximately one-fifth of patients present to the hospital with coagulation disorders.2,4 The inflammatory and thrombotic processes in these patients are closely related. Some consensus on the Fig. 2. Lung involvement supported by computed tomography (peripheral ground-glass opacification) (blue arrows). Fig. 3. Computed tomography angiography image shows thrombosis within the aorta at the level of the thoracoabdominal aorta (red frame). Fig. 4. Computed tomography angiography image depicts thrombus images at the initial levels of both iliac arteries in the aortic bifurcation (blue arrows). Fig. 5. Thrombus image extracted from the aorta and iliac arteries after bilateral femoral embolectomy.
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