ASSOTIATION BETWEEN COVID-19 AND SUPERFICIAL VENOUS THROMBOSIS OF THE UPPER EXREMITY – CASE REPORTS
Keywords:
Superficial venous thrombosis (SVT), Upper extremity, COVID 19, Post covid syndromeAbstract
Superficial venous thrombosis (SVT) is inflammation of the surface veins of lower or upper extremities, often associated with thrombosis. Traditionally SVT is more common in lower extremities. More rarely it is found in upper extremity, breast, chest wall or penis venous systems. Cases of SVT of the arm are mostly associated with venous manipulations and are self limited. In the course of COVID 19 pandemic many evidences for association between the disease and increased risk of venous thrombosis and pulmonary embolism were gathered. Possible causes for hypercoagulability associated with SARS CoV 2 infection are endothelial dysfunction, hypoxemia etc. Additional factors that increase the risk of venous thromboembolism are the immobilization, respiratory failure and peripheral or central venous catheter usage.
Materials: We present two cases of patients recovered from COVID 19 and later diagnosed with SVT of the upper extremity. The affected vessels were not intervened.
Case report 1: Sixty seven year old male, treated in COVID 19 ward from mild to severe SARS CoV 2 infection for 14 days. On the 4th day after the discharge, presented at the Clinic of Vascular surgery with pain and erythema in the medial portion of the right arm and forearm. Vascular status: erythema and swelling in the region of basilic vein form distal part of the forearm to the proximal part of the arm. No visible signs of venepunction, no swelling of the wrist and fingers. Present pulses on wrist arteries. Duplex ultrasound (DUS): hyperechogenic thrombus along the entire length of the basilic vein. Patient deep venous system. Laboratory: no deviations, including D dimer. Inhospital treatment: Enoxaparin 0,6ml s.c. BD, Dexketoprofen 100mg i.v. BD, Venotonic, Elastic compression. Treatment at discharge: Rivaroxaban 20mg QD, Heparin unguent, Venotonic, Elastic compression.
Case report 2: Twenty nine year old male, recovered from COVID 19 twice. The patient was treated at home and had mild disease. The second episode of SARS CoV 2 infection was diagnosed 20 days prior to the vascular complication. The patient did not take the prescribed antiplatelet therapy. Three days after recovery from COVID
19, noticed swelling and erythema in right wrist area. Vascular status: Erythema, and painful swelling in the lateral area of the right wrist joint, no visible evidences of venepunction. DUS: hypoechogenic thrombus in the distal portion of the right cephalic vein. Patient deep venous system. Treatment: Heparin unguent, Venotonic, Elastic compression.
Discussion: According to different estimates SVT of the lower extremities varies between 3 11% of the population. Superficial venous thrombosis of the arm is much more rare, but can lead to functional disability of the arm, due to severe pain.
Conclusion: Although rare SVT of the upper extremity usually is benign and self limiting. The attention of General practitioners should be sharpened for this type of complications in patients who have survived COVID 19, even in mild form, to ensure early diagnosis and adequate treatment.
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