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    UNUSUAL PRESENTATION OF THROMBOEMBOLIC DISEASE IN A HOSPITALIZED PATIENT WITH A COVID-19 INFECTION: A CASE REPORT
    (Macedonian Association of Anatomists and Morphologists, 2021-12)
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    Nedeska Minova, Natasha
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    Terzievska, Keti
    With no ideal specific therapy confirmed by the science community, and many low income countries barely being able to obtain a sufficient number of vaccines, as well as the long-term mental health impact, the COVID-19 infection makes for a worldwide health and global problem. A COVID-19 positive patient was admitted due to poor condition, malaise and bilateral interstitial pneumonia with borderline oxygen saturation of 94%, hypoxemia with pO2 of 64mmHg, and elevated C reactive protein (CRP) of 70. The patient was put on oxygen support of 3l/min, and started parenteral antibiotic and LMWH in prophylactic doses - a combination that primarily improved the patient’s condition. Three days after hospitalization marked shortness of breath with a drop in oxygen saturation of 62% referred. With further increasing of the oxygen flow, and a transfer to ICU, gas pressures showed significant worsening and the patient was put on mechanical support with a CPAP mask. Despite adding pulsed doses of potent corticosteroid, rapid acting insulin for blood glucose control, and administerring convalescent plasma and parenteral nutrition, the CRP levels were increasing and oxygen was decreasing. Hypotensive, tachycardic and with reduced urine output, the patient was intubated and set up on IPPV mechanical support. Vasopressor stimulation didn’t improve the diuresis and elevation of degradation products followed, as well as elevation of the troponin and cardiospecific enzymes - non of which was caused by sepsis. Eight days after admission, the left arm presented as pale, cool and cyanotic. Fully deteriorated laboratory findings of multiple organ system failures (MOFS) were undoubtable; with the oxygen levels incompatible of life, and a CT scan with ARDS presentation, a continuous heparin infusion was the only solution. At the beginning, nothing indicated the deleterious outcome; however, with a highly unusual presentation of arterial thrombosis, the upper limb gangrene became too much and the patient died. COVID-19 is primary a respiratory infection, but the virus can affect other organs and systems, with some very rare presentations and deleterious outcomes.
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    Arterialisation of great saphenous vein in patient with critical limb ischemia: Case report
    (Vilnius University Press, 2018-11-14)
    Vlatko Cvetanovski
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    Andreja Arsovski
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    Liljana Stojanovska
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    Zoran Dimitrov
    Critical lower limb ischemia in the absence of distal arterial circulation presents an urgent situation, which must be treated immediately if we want to save the foot or limb from amputation.The reduced arterial ow in these situations is not adequate to provide metabolic requirements of lower limb even in rest.According to Fountain these patients are classi ed in Class III or in Class IV.Approximately 14%–20% of patients with critical lower limb ischemia are unsuited for distal arterial reconstruction and face major distal amputation [1]. Distal venous arterialization is a unique procedure in which the venous bed is used as an alternative conduit for perfusion of peripheral tissues of lower limb. Patients with critical lower limb ischemia can be treated by arterialization of great saphenous vein.Case reportIn the present article, we describe the rst case of in situ arterialization of great saphenous vein performed in Macedonia in treatment of critical below-knee ischemia. Maintaining the great saphenous vein in situ allows the arterialization of the foot venous arch with one anastomosis without removing the vein of its original bedConclusionDistal revascularization of the limb with critical ischemia, by creating a reverse ow with in situ saphenous vein arterialization must be seriously considered as an attempt for salvage of the foot or below-knee without distal arterial run-o .