Radiological findings of COVID-19-related thromboembolic complications

Background The ongoing global pandemic of coronavirus disease 2019 (COVID-19) may cause, in addition to lung disease, a wide spectrum of non-respiratory complications. Among these are thromboembolic complications. The theories that explain the mechanism of thromboembolic complications of COVID-19 are accumulating rapidly, and in addition to the role of imaging for assessment of COVID-19 pneumonia, CT may be useful for identification of these complications, such as pulmonary embolism, ischaemic stroke, mesenteric ischaemia, and acro-ischaemia. Results Thromboembolic manifestations were diagnosed in 10% of our patients (124 patients out of the total 1245 COVID-19 patients); 56 patients (45.2%) presented with pulmonary embolism, 32 patients (25.8%) presented with cerebrovascular manifestations, 17 patients (13.7%) presented with limb affection, and 19 patients (15.3%) presented with gastrointestinal thromboembolic complications. Most of our patients had significant comorbidities; diabetes was found in 72 patients (58%), dyslipidemia in 72 patients (58%), smoking in 71 patients (57.3%), hypertension in 63 patients (50.8%), and morbid obesity in 40 patients (32.2%). Thromboembolic events were diagnosed on admission in 41 patients (33.1%), during the first week in 61 patients (49.2%), and after the first week in 22 patients (17.7%). Conclusions The incidence of thromboembolic complications in COVID-19 patients is relatively high resulting in a multisystem thrombotic disease. In addition to the crucial role of imaging for assessment of COVID-19 pneumonia, CT is important for assessment of the thromboembolic complications, such as pulmonary embolism, ischaemic stroke, mesenteric ischaemia, and peripheral ischaemia, especially in patients with elevated d-dimer levels and those with sudden clinical deterioration.

Patent foramen ovale

Patent foramen ovale (PFO) is the most common anatomical cause of an interatrial shunt. It is usually asymptomatic but may cause paradoxical embolism, manifesting as stroke, myocardial infarction or visceral/peripheral ischaemia. PFO is a risk factor for stroke and may be associated with migraine with aura. New evidence suggests PFO closure reduces the risk of recurrent ischaemic stroke in a highly selected population of stroke survivors: those aged 60 years or younger with a cryptogenic stroke syndrome, a large right-to-left shunt, an atrial septal aneurysm and no evidence of atrial fibrillation. They benefit from percutaneous PFO closure in addition to antiplatelet therapy, rather than antiplatelet therapy alone. Current evidence does not support PFO closure in the treatment of migraine.

Vascular surgery

Vascular conditions are common in surgical nursing care and range from varicose veins to more complex arterial disease. This chapter gives the nurse an understanding of the assessment process for vascular conditions, the associated anatomy and physiology, and treatment modalities. The chapter also focuses on specific conditions, including amputation, venous disease, ulcers, and arterial conditions such as abdominal aortic aneurysm, peripheral ischaemia, and carotid disease.

Chronic wound and postamputation claudication pain in a diabetic patient

Underlying ischaemic disease should be excluded in patients with delayed wound healing. Contrast angiography is a useful imaging method for assessing the specific cause of wound chronicity and may also be helpful in assessing the aetiology of unexplained pain symptoms. Angioplasty provides a practical alternative to more invasive techniques in addressing peripheral ischaemia. Our patient suffered claudication-type pain in his thigh and a non-healing stump wound following below-knee amputation. Magnetic resonance angiography confirmed the presence of arterial stenoses and an angioplasty was successfully performed to improve patency of the profunda femoris vessel. Following the operation, the claudication pain symptoms were significantly reduced and the stump wound went on to heal.

Gene therapy with vascular endothelial growth factors

Therapeutic angiogenesis is a promising new concept for the treatment of myocardial and peripheral ischaemia. Members of the VEGF (vascular endothelial growth factor) family are among the most powerful modulators of angiogenesis. They regulate vascular growth and maintenance during embryogenesis and in adults. The present review summarizes the current status of therapeutic angiogenesis using VEGF, with special reference to preclinical studies.