Результаты хирургического лечения острой ишемии нижних конечностей у пациентов с инфекцией SARS-COV-2

В.Я. Хрыщанович, И.П. Климчук, Н.А. Роговой, Е.В. Нелипович, А.Г. Павлов

Белорусский государственный медицинский университет, 4-я городская клиническая больница им. Н.Е. Савченко, г. Минск

Коронавирусная болезнь 2019 (COVID-19) относится к вирусным респираторным инфекциям и является предрасполагающим фактором для развития венозных и артериальных тромботических событий вследствие выраженного воспалительного ответа, активации тромбоцитов, эндотелиальной дисфункции и замедления кровотока. Недавние исследования подтвердили крайне высокую частоту встречаемости тромбоэмболических событий, в особенности в группе пациентов с тяжелым течением коронавирусной пневмонии. В период пандемии COVID-19 стало появляться все больше сообщений о возникновении тромбозов периферических артерий у пациентов отделений интенсивной терапии, находящихся в критическом состоянии. При этом острая ишемия конечностей нередко возникает в отсутствие серьезных коморбидных состояний и сопровождается высокими показателями ампутаций и летальных исходов.
В настоящем сообщении представлены результаты лечения 14 пациентов с инфекцией SARS-CoV-2 и острой ишемией нижних конечностей. Серия клинических наблюдений свидетельствует о неэффективности открытой тромбэктомии и стандартной парентеральной антикоагуляции более чем в одной трети случаев. С целью разработки оптимальной терапевтической стратегии необходимо продолжить изучение патогенетических механизмовразвития COVID-19-ассоциированного артериального тромбоза.

ключевые слова: коронавирусная болезнь 2019, SARS-CoV-2, тромбоз, острая ишемия нижних конечностей.

для цитирования: В.Я. Хрыщанович, И.П. Климчук, Н.А. Роговой, Е.В. Нелипович, А.Г. Павлов. Результаты хирургического лечения острой ишемии нижних конечностей у пациентов с инфекцией SARS-CoV-2. Неотложная кардиология и кардиоваскулярные риски, 2022, Т. 6, № 1, С. 1547–1554.

Results of surgical treatment of acute lower limb ischemia in patients with SARS-COV-2 infection

V. Khryshchanovich, I. Klimchuk, N. Rogovoy, E. Nelipovich, A. Pavlov

Coronavirus disease 2019 (COVID-19) refers to viral respiratory infections and is the predisposing factor for the development of venous and arterial thrombotic events due to a pronounced inflammatory response, platelet activation, endothelial dysfunction and stasis. Recent studies have confirmed an extremely high incidence of thromboembolic events, especially in the group of patients with severe coronavirus pneumonia. There have been an increasing number of reports of peripheral arterial thrombosis as well. Most cases of arterial thrombosis are noted in critically ill patients in intensive care units. At the same time, acute limb ischemia often occurred in the absence of serious comorbid conditions and was accompanied by high rates of amputations and deaths.
Herein we report the results of management of 14 patients with severe SARS-CoV-2 infection and acute lower limb ischemia. Our own series of clinical observations shows that open thrombectomy and standard parenteral anticoagulation are ineffective in more than one third of cases. The pathogenesis mechanisms of COVID-19-associated arterial thrombosis should be further investigated in order to develop an optimal therapeutic strategy.

keywords: Belarusian State Medical University, 4 th City Clinical Hospital named after N.E. Savchenko, Minsk

for references: V. Khryshchanovich, I. Klimchuk, N. Rogovoy, E. Nelipovich, A. Pavlov. Results of surgical treatment of acute lower limb ischemia in patients with SARS-CoV-2 infection. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2022, vol. 6, no. 1, pp. 1547–1554.

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