Outcomes of Patients With Acute Limb Ischemia in Patients With COVID-19: A Systemic Review and Meta-Analysis

A systemic review and meta-analysis of perioperative outcomes of acute limb ischemia (ALI) in patients with and without coronavirus disease-2019 (COVID-19) to determine the outcomes of ALI and compare the outcomes in patients with and without COVID-19 infection. A literature search of the Medline, Science Direct and Cochrane Library was performed from inception to July 15, 2021. Studies involving ALI in patients with COVID-19 were searched through three electronic databases. The endpoints include limb salvage, re-thrombosis, and mortality, and these outcomes were compared between patients with and without COVID-19 infection and type of management. The primary outcome was early limb salvage (till the patient was discharged from the hospital). The other outcomes assessed were re-thrombosis and mortality. These outcomes were compared between patients with and without COVID-19 infection and the type of management. Pooled estimates were presented as odds ratios (ORs) using a random or fixed effect model based on the results of the chi-square test and calculation of I(2). Comparing the ALI outcomes in patients with and without COVID-19 infection, there was no significant difference in limb salvage rate (OR=0.26, 95% CI:0.02-3.09), but there was a significantly higher re-thrombosis (OR=2.65, 95% CI:1.34-5.23) and mortality rate (OR=4.71, 95% CI:1.11-19.99) in patients with COVID-19 infection. On comparing outcomes based on management, intervention group, and anticoagulant alone group, no significant difference was noted concerning limb salvage (OR=1.40, 95% CI:0.27-7.13) and mortality rates (OR=0.2, 95% CI:0.04-1.07). This meta-analysis demonstrates a higher re-thrombosis and mortality in ALI patients with COVID-19 infection when compared to patients without COVID-19 but with similar limb salvage.