Introduction COVID-19 is a novel coronavirus which typically results in upper respiratory symptoms. However, we describe the acute arterial and venous thrombotic events following COVID-19 infection. Managing acute thrombotic events from the novel virus presents unprecedented challenges during the COVID-19 pandemic. Our study highlights the unique management of these patients and discusses the role of anticoagulation in patients diagnosed with COVID-19. Methods Data for 21 patients with laboratory confirmed COVID-19 disease and acute venous or arterial thrombosis were collected. Patients were analyzed on the basis of demographics, comorbidities, home medications, laboratory markers, and outcomes. The primary postoperative outcome of interest was mortality and secondary outcomes were primary patency and morbidity. To assess for significance, univariate analysis was performed using Pearson χ2 and Fisher exact tests for categorical variables and Student t-test for continuous variables. Results 21 patients with acute thrombotic events met our inclusion and exclusion criteria. The majority of cases were acute arterial events (76.2%) while the remainder were venous cases (23.8%). The average age of all patients was 64.6 years-old and 52.4% were male. The most prevalent comorbidity in the group was hypertension (81.0%). Several markers were markedly abnormal in both arterial and venous cases, including an elevated neutrophil: lymphocyte ratio (8.8) and d-dimer (4.9 mcg/mL). Operative intervention included percutaneous angiogram in 25.00% of patients and open surgical embolectomy in 23.8%. The majority of arterial interventions had a postoperative complication (53.9%) versus a 0% complication in the venous interventions. AKI on admission was a factor in 75.0% of mortalities versus 18.2% in survivors (p=0.04). Conclusion We describe our experience in the epicenter of the pandemic of 21 patients who experienced major thrombotic events from COVID-19. Our cohort highlights the need for increased awareness of vascular manifestations of COVID-19 and the important role of anticoagulation in these patients. More data is urgently needed to optimize treatments and prevent further vascular complications of COVID-19 infections.

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Objective: During the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns, and outcomes of these vascular access teams during the COVID-19 pandemic. Methods: We conducted a cross-sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. To participate in the study, hospitals were required to meet one of the following criteria: development of a formal plan for a central venous access line team during the pandemic; implementation of a central venous access line team during the pandemic; placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice; or management of an iatrogenic complication related to central venous access in a patient with COVID-19. Results: Participants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis (Santa Clara, Calif) catheters, and nontunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience in placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of the hospitals. Less than 50% (24 [41%]) of the participating sites reported managing thrombosed central lines in COVID-19 patients. Twentythree of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group). Conclusions: Implementation of a dedicated central venous access line team during a pandemic or other health care crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed health care system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained intensive care unit, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future health care crises.

Based on the articles reviewed in this article, a more uniform definition needs to exist that is clearly defined in all articles that report on fat necrosis. The authors suggest defining fat necrosis as a palpable, discrete, and persistent subcutaneous firmness found postoperatively that measures at least 1 cm during physical examination. Fat necrosis can be identified and confirmed by imaging and histopathology or through intraoperative findings. The authors provide a classification system for fat necrosis that can be used by clinicians to describe fat necrosis into varying grades of severity to ultimately help guide clinical decision-making.