I am very fascinated with your post Harvey. Personally, have not seen any of these patients. But I am with you - it would seem given your description of a more chronic versus episodic patient presentation, unlikely to be Neurogenic and Raynaud's.
There is certainly some evidence to suggest that the COVID virus may reside or certainly it travels within the vascular system. This would explain the far reaching effects the virus inflicts on some individuals. We do know that in some patients, especially those with severe COVID, platelets often get incredibly high, way out of control and the entire clotting cascade is altered. I wonder whether the thrombosis phenomena, which has been widely reported, more likely occurs in the microvasculature, the capillaries and possibly the smaller arterioles and venules. Most of the descriptions of this phenomena in the literature seem to point to this possibility. While some of these patient's may also have US detectable DVT, it appears this is perhaps somewhat less common. If in fact, the thrombosis occurs on the venule side of the capillary beds, one may not see a large reduction in the PO2 until it reaches a phlegmasia type of phenomena - a severely reduced outflow results in such elevated tissue pressure that it can begin to limit arterial inflow. And it would seem, given its size, the digit could be the most likely scenario where this could occur. One other fascinating fact - there is some evidence to suggest that blood pressure control may be lost on a LOCAL level - that is systemic pressure is stable but at an organ or organ system level, may be very low or very high. Again, all conjecture on my part. We just do know (yet!)
Please let us know if you get more cases and can enlighten us.
Thanks.
Bill
William B Schroedter, BS, RVT, RPhS, FSVU
4120 Woodmere Park Blvd
Suite 8B
Venice, Florida 34293
www.qualityvascular.com
www.virtualveincenter.com
-----Original Message-----
From: UVM Flownet <[log in to unmask]> On Behalf Of Harvey Wilson
Sent: Wednesday, February 10, 2021 1:06 PM
To: [log in to unmask]
Subject: Covid toes
Hi all,
I wanted to ask if anyone has had much experience with adult patients with possible "Covid toes" The past few months I have seen a number of adults with purplish, sometimes painful toes, even some spots which might look embolic. No one has knowingly had the virus but we know how that goes...
PPG's are generally a mix of lower amplitude, absent and normal dichrotic notch. A real mixed bag so I just don't know if there's even anything to be done. Could even be Neurogenic or Raynauds but unlikely.
Any thoughts would be appreciated, thanks!
Harvey
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