Associations between SARS-CoV-2 infections and thrombotic complications necessitating surgical intervention: A systematic review

Table 1 Synopsis of reviewed studies on coronavirus disease 2019 thromboembolisms necessitating surgical intervention

Ref.	Location	Study design	No. of patients	Age (yr)	Sex: Males, females (%)	Comorbidities	Thromboprophylaxis	Thromboembolic complication(s)	Surgical intervention(s)	Outcome
Adekiigbe et al[43], 2020	NY, United States	Case report	1	47	Male	DM	Yes	Cutaneous vasculitic lesions and gangrene of all toes, bilateral DVT	Bilateral transmetatarsal amputations of all 10 toes	Discharged home
Ali Nasir et al[20], 2021	Pakistan	Case report	1	64	Male	T2DM, HTN	No	Acute LLI	Above knee amputation	Discharged home
Balanescu et al[33], 2021	MI, United States	Case series	4	20-77 (median 52)	Male (50)	Obesity (50%)	Unknown	PE	Mechanical thrombectomy (100%)	Discharged home (100%)
Bilge et al[21], 2021	Turkey	Case report	1	73	Male	HTN	No	Upper extremity arterial thromboembolism	Left upper extremity arteriotomy and arterial thrombectomy. Repeat thrombectomy 12 h later. Amputation at the level of the forearm 13 d later. Stump revision with amputation 22 d later	Discharged home
Bozzani et al[22], 2020	Italy	Case series	6	71 (49-83)	4 males (66)	3 PAD, other unknown	Unknown	Acute LLI	Urgent revascularization procedures (embolectomy in 3 cases, and hybrid open/endo procedures in other 3)	1 rethrombosed day 5, died 30 d later of MOF. 1 rethrombosed day 5, repeat embolectomy, above knee amputation. 4 discharged home. 23 discharged home in good condition
Cheung et al[55], 2020	NY, United States	Case report	1	55	Male	HTN	No	SMA thrombosis, bowel ischemia	Emergency exploratory laparotomy and SMA thrombectomy, necrotic small bowel resection	Discharged home
Dao et al[56], 2021	CA, United States	Case report	1	61	Male	HTN	Yes	Free floating descending aortic thrombus	Percutaneous vacuum assisted aortic thrombectomy	Discharged home
Dinoto et al[23], 2021	Italy	Case report	1	78	Male	DM, obesity, prior remote endovascular surgery for large popliteal aneurysm	No	Acute LLI. Thrombosis of left femoral-popliteal stent	Mechanical thrombectomy	Discharged home
Galastri et al[34], 2020	Brazil	Case report	1	57	Male	DM, obesity, HTN	Yes	Massive PE	Catheter directed thrombolysis	Discharged home
Gutierrez et al[39], 2022	NY, United States	Case report	1	53	Male	HTN, remote smoking, DM	Yes	Due to phlegmasia cerulean dolens	Fasciotomy and mechanical thrombectomy	Discharged PAD 70
Hwabejire et al[19], 2021	MA, United States	Case series	20	58 ± 7	13 males (65)	Obesity (60%)	85% (17) received preoperative anticoagulation	Acute bowel ischemia	Laparotomy with resection of bowel	50% overall mortality rate: (1) 100% mortality in patients ≥ 65 yr; (2) 33% mortality < 65 yr; and (3) 40% (8) developed
Jamshidi et al[40], 2021	CA, United States	Case report	1	51	Male	Tricuspid atresia status post Fontan and extracardiac Shunt	Yes	Bilateral lower extremity DVT, phlegmasia cerulea dolens of the left lower extremity	Catheter directed mechanical thrombectomy (PAD 13), left below knee amputation (PAD 41)	Discharged to rehabilitation facility PAD 50
Khanna et al[32], 2021	PA, United States	Case report	1	67	Female	HTN	No	Acute stroke from bilateral anterior circulation large vessel occlusion	Bilateral simultaneous mechanical thrombectomy	Full neurologic recovery
Nascimbene et al[35], 2021	TX, United States	Case report	1	44	Male	Patent foramen ovale, T2DM, HTN, dyslipidemia, obesity	No	Massive PE with a large right atrial thrombus	Percutaneous right and left atrium embolectomy	Discharged home
Naudin et al[24], 2021	France	Case report	1	56	Male	T2DM, HTN, obesity	No	Acute aortoiliac thrombus and LLI	Aortoiliac and lower limb artery mechanical thrombectomy and left lower limb fasciotomies, subsequent left below knee amputation	Extubated but still in ICU 6 wk post operatively
Szeles et al[25], 2021	NY, United States	Case report	1	67	Male	DM, hyperlipidemia, HTN	No	Acute LLI and aortic mural thrombosis	Emergency bilateral aortoliliac and distal embelectomies, followed by transmetatarsal amputation of the right foot and below knee amputation of the left limb
Topcu et al[26], 2021	Turkey	Single center cross sectional study	3	62 (58-70)	3 (100)	1 ex-smoker	Yes (100%)	Acute LLI	3 emergency surgical thrombectomy	1 minor amputation (33.3%); 1 death (33.3%); 1 bilateral major amputation (33.3%)
Traina et al[18], 2021	Italy	Case report	1	80	Male	CVD, prior endovascular aortic repair in 2019 for abdominal aneurysm repair, and dyslipidemia	No	Bowel ischemia with aorto-enteric fistula formation	Laparotomy with resection of necrotic small bowel (occult COVID-19, diagnosed on histologic examination of resected small bowel)	Discharged home
Vyas et al[36], 2020	NY, United States	Case report	1	32	Male	None	No	Large saddle pulmonary embolus	Bilateral percutaneous pulmonary artery mechanical thrombectomy	Discharged home 3 d post procedure
Yang et al[17], 2021	Germany	Cohort study	20	69 (62-72)	15 males (75)	65% (13) obese	25% (5)	Colonic ischemia	12 (60%) underwent (sub)total colectomy, 7 (35%) right hemicolectomy, 1 (5%) ileocecal resection	9 (45%) surgical complications, 10 (50%) required revision surgery, 9 (45%) mortality
Zivkovic et al[57], 2021	Serbia	Case report	1	44	Female	None	No	Ascending aorta floating thrombus with acute right arm ischemia	Surgical thrombus extraction through open sternotomy and bypass surgery	Discharged POD 6
Madani et al[27], 2021	CA, United States	Cases report	1	40	Male	HTN, T2DM	Yes	Acute LLI	Right lower extremity above knee amputation	Discharged 41 d after admission

DM: Diabetes mellitus; DVT: Deep venous thrombosis; HTN: Hypertension; LLI: Lower limb ischemia; PE: Pulmonary emboli; MOF: Multi organ failure; SMA: Superior mesenteric artery; PAD: Peripheral artery disease; ICU: Intensive care unit; CVD: Cardiovascular disease; COVID-19: Coronavirus disease 2019; POD: Post op day.