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SINGAPORE: Doctors at Tan Tock Seng Hospital (TTSH) have successfully treated a COVID-19 patient who developed a blood clot in the aorta and was at risk of losing his toes or leg. Subsequently, the medical team became the first in the world to publish research on the subject.
The patient, a 39-year-old Bangladeshi worker who was hospitalized in May, was “a somewhat unusual case,” with a blood clot in the thoracoabdominal aorta, TTSH chief of general surgery, the adjunct adjunct professor Glenn Tan (October 13).
The thoracoabdominal aorta extends from the chest to the abdomen and is part of the aorta, which is the largest artery in the body.
The development of a blood clot in the aorta is unusual because blood flow in the aorta is usually very high, as it comes directly from the heart, said Dr. Tan, who was the presiding surgeon.
Time was of the essence in treating the patient because the blood clot could travel to other organs or to his legs, causing further complications. You could even lose your toes or leg due to gangrene, which means you could no longer work as a delivery boy in Singapore.
Opening his chest to directly remove the clot from the aorta meant that everyone involved in the surgery would be exposed to COVID-19. This is in part why the team opted for a less invasive procedure, Dr. Tan said.
In a two-hour operation on May 8, doctors inserted an aortic stent into the aorta to trap the blood clot against the wall of the blood vessel and prevent it from dislodging, he added. They then removed the blood clots from the patient’s leg to restore blood flow there.
Adjunct Assistant Professor Glenn Tan and Adjunct Associate Professor Pua Uei, who participated in the surgery, demonstrated how to use the device used to insert the stent into the aorta. (Photo: Ang Hwee Min)
The doctors subsequently published an article in the British Journal of Surgery, the first publication in Asia involving the treatment of arterial blood clots in COVID-19 patients. It is also the first publication in the world to describe blood clots in the aorta in COVID-19 patients.
FINDING THE SOURCE OF THE PROBLEM
The patient, Mr. Ullah Kefayet, tested positive for COVID-19 in May after running a fever and experiencing shortness of breath. Two or three days after he was protected, he felt pain in his right foot and his toes had turned black.
Condition of Mr. Ullah Kefayet’s toes with gangrene before surgery. (Photo: TTSH)
Since it was “very unusual” for young people to have gangrene in the legs if they had no other underlying medical conditions, the doctors decided to perform a CT scan to find out what could have caused it.
The scan found a blood clot in the aorta, and parts of the clot had also dislodged and moved to his right leg, spleen and kidneys, Dr. Tan said. Aside from gangrene, this puts the patient at risk for kidney failure or blood clots in the gastrointestinal tract.
“So it was quite disturbing for a very young gentleman who couldn’t walk. And he felt, how will he get better and get back to work? And not only that, at this moment his life was at risk, and he is also at risk of losing his toes and possibly his leg, “he added.
Timeline: No new COVID-19 cases in Singapore bedrooms for the first time in more than 6 months
One month after surgery, the gangrene patches on Mr. Ullah’s toes began to disappear and he began to walk alone. Three months after the surgery, all the black spots had disappeared.
He finally returned to work as a parcel delivery driver three weeks ago.
Speaking to reporters on a video call, Ullah said his family thought he had died because he did not contact them for a few days while he was in the intensive care unit after surgery.
Adding that he was initially concerned for his health when he tested positive for COVID-19, Mr. Ullah, who has worked in Singapore for 14 years, said he was relieved to regain the use of his right leg.
PREPARING FOR SURGERY IN THE MIDST OF COVID-19
Although the stent procedure is performed frequently, preparations by the TTSH team and the National Center for Infectious Diseases helped quickly set up logistics for the operation amid COVID-19 restrictions, said Adjunct Adjunct Professor Pua Uei, Principal Consultant in Diagnostic Radiology. .
“And we have been preparing this for a long time. So this really helped us get him to surgery in a very safe and timely manner, ”he added.
Adding that it is “very challenging” to operate on patients in the midst of the pandemic, especially those who are COVID-19 positive, Dr. Tan noted that everyone involved in the surgery had to wear N95 masks, which are more uncomfortable than what. They’re used to it. .
“It is a very challenging environment to operate. But we have been preparing this for a while, so we are not new to the scene.”
READ: COVID-19 case dies from a blood clot in the pulmonary artery more than 2 weeks after recovery, discharge: MINSA
Blood clots have caused complications in other COVID-19 patients. In June, a 41-year-old man died of a blood clot in an artery in his lungs, two weeks after he recovered from the virus and was discharged from the hospital.
In May, the Health Ministry issued a warning to all physicians to be “vigilant” for possible cardiovascular problems in COVID-19 patients.
Noting that approximately one in 1,000 COVID-19 cases in Singapore experienced “cardiovascular events, such as heart attacks and blood clots,” Health Minister Gan Kim Yong said that doctors should take extra precautions.
When the COVID-19 pandemic first struck, most doctors thought it was “just a respiratory illness,” Dr. Tan said.
But as we went along, we found that it caused more problems. It caused clotting problems and not only in the arteries, but also in the veins. Not only in the legs, there were also clots in the heart, some people were at risk of heart attacks, clots in the brain that can cause strokes, “he added.
“I think we’ve been lucky because most of our patients have been in the younger age group and are less seriously ill,” said Dr. Tan, when asked how common blood clots are in patients with COVID-19.
According to the surgeon, these patients have been found to develop antibodies that cause their blood to become “sticky.” Some of them also see inflammation in the wall of the blood vessels, which causes a predisposition to blood clots.
“But so far we are still not very clear … how it happens. We still don’t know, we are still not clear about this. At the time most parts of Europe and America have reported this, we still have only theories but no confirmed definite cause. ”
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