COVID related clots causing near fatal intestinal gangrene – Enter minimally invasive vascular surgery!!
Mumbai - It is well known that COVID 19 causes a highly thrombogenic (clot forming) state in the body but most of our focus is on the lungs, but at the same time acute intestinal blood vessel clots are potentially incurable with overall mortality of 60 to 80% with most cases requiring removal of the gangrenous part of intestine. A mixture of both usually is very morbid with high death rates as per world data and nearing dozen of patients found in Mumbai recently. Dr. Aniruddha Bhuiyan, Consultant Vascular and Endovascular Surgeon, Mumbai has saved lives of COVID 19 positive patients with intestinal arterial clots by minimally invasive breakdown of clots causing reversal of gangrene process in the intestine and thus not requiring any open bowel surgery.
Giving more information on this subject Dr. Aniruddha Bhuiyan said,” We are reporting in such patient’s severe abdominal symptoms with minimal to no respiratory symptoms in COVID 19. I wanted to get this complication of Covid 19 out as people misinterpret abdominal pain in Covid as other symptoms which lead to delayed presentation and Death. We have seen multiple patients, the youngest being 37 yrs and oldest being 58 yrs with these symptoms. Most common presentation is usually very severe abdominal pain not relieved by medications. Such patients are usually screened by CT scan of the abdomen which usually shows a blood clot in the artery supplying the intestine. Early intervention by removal of clot either surgically or via minimally invasive catheter directed methods can lead to immediate restoration of blood supply ultimately resulting in complete relief for the patients. In our patients the catheter is placed either from the thigh or the arm and access is guided into the artery supplying the intestine. Immediate clot liquification is done by thrombolysis and a small tube is guided via image intensifier into all the small vessels and clots are sucked out. The patient usually gets immediate pain relief and he/she can immediately walk after the procedure. This is especially important in Covid patients who have respiratory issues to be managed thus reducing their overall morbidity.
The First Reported cases worldwide for COVID positive patients was done by Dr. Aniruddha Bhuiyan, Vascular and Endovascular Surgeon, Mumbai with COVID 19 associated intestinal (mesenteric) artery blockage – Treated with minimally invasive methods (Endovascular) and didn’t require removal of the intestine with reversal of gangrene process. This case has been published in Indian Journal of Surgery in April 2021.