Patients with coronavirus disease 2019 (COVID-19) and comorbidities who present with elevated levels of inflammatory markers and D-dimer may have an increased risk for large vessel peripheral arterial occlusion, according to a study published in Clinical Imaging.

In this retrospective study, the data of 9 patients (average age, 71 years; age range, 37-93 years; 6 women) with COVID-19 who underwent extremity computed tomography angiography (CTA) for large vessel extremity arterial occlusion were examined. The patients had presented to a multihospital health care system in New York City between February 1, 2020, and April 30, 2020. Patients’ medical history and clinical parameters were reviewed to identify common risk factors including obesity, hypertension, hyperlipidemia, and diabetes.

In 8 patients, levels of C-reactive protein (CRP), D-dimer, and ferritin levels were measured. CRP and D-dimer levels were elevated in all 8 patients and ferritin was elevated in 7 patients. Erythrocyte sedimentation rate was elevated in all 6 patients tested, and white blood cell count was elevated in 6 of the 9 patients. A total of 6 patients had long segment lower extremity arterial occlusions which were bilateral for 1 of the 6 patients.

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Study limitations include its retrospective design, the fact that only CTAs were reviewed, and that a single unblinded radiologist viewed the images, precluding an evaluation of interobserver variability.

“Peripheral extremity arterial occlusion can be a presenting feature of COVID-19,” noted the study authors. “Patients with a history of obesity or hypertension, with increased inflammatory markers and elevated D-dimer, are potentially at increased risk. This observation suggests consideration for a lower threshold for performing CTAs on these patients, particularly if presenting with extremity symptoms. Additional studies with larger patient numbers are indicated to further study patients at risk for extremity arterial occlusion in COVID-19 and to evaluate which therapy may be most beneficial for this patient population.”


Ogawa M, Doo FX, Somwaru AS, et al. Peripheral arterial occlusion due to COVID-19: CT angiography findings of nine patients. Clin Imaging. 2020;73:43-47.