A Comparative Analysis of Critical Limb Ischemia in the Intensive Care Unit since the COVID-19 Pandemic

Malkoc, Aldin; Gnanadev, Raja; Botea, Lev; Jeney, Ashtin; Glover, K.; Retamozo, Milton; GnanaDev, Dev; Schwartz, Samuel

doi:10.1016/j.avsg.2022.11.001

Cited by 3 publications

(9 citation statements)

References 18 publications

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“…COVID-19 positivity was diagnosed or confirmed in most of the studies [27][28][29][30][31]33,35] with PCR upon admission for ALI to the vascular unit. In two studies, the infection was determined both with Nasopharyngeal swab and Chest X-rays [34,36].…”

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 93%

“…The systematic review of the literature collected 11 different studies, for a total of 15,803 patients. Seven of these were retrospective studies [22,[27][28][29][30][31][32], three were prospective [33][34][35], while one [36] was a prospective study that included a comparison group formed by a retrospectively collected cohort.…”

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 99%

“…Five studies [27,29,31,32,36] included as a comparison group a cohort of pre-COVID patients, who had been treated for ALI in the period between 2017 and 2019. Four further studies, [22,30,33,34] considered for comparisons negative patients treated concurrently as COVID-19-positive patients.…”

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 99%

“…A high range of geographical heterogeneity was found throughout the studies, as they were conducted across five different continents (five in North America [22,[27][28][29]32], three in Europe [34][35][36], one in South America [33], one in Africa [30], and one in Asia [31]).…”

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 99%

“…More than one half of the studies (7 out of 11) included patients admitted to single specialized/tertiary vascular or trauma medical centers [27][28][29][30]33,35,36], whereas in one study, data were collected from a network of four regional vascular surgery hubs [34]. In three further studies, data were extracted from electronic medical records from networks of healthcare organizations [22,32] or obtained from medical records of two tertiary vascular centers [31].…”

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 99%

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The Impact of COVID-19 on Amputation and Mortality Rates in Patients with Acute Limb Ischemia: A Systematic Review and Meta-Analysis

Crupi,

Ardizzone,

Calapai

et al. 2024

Diseases

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Since the inception of the SARS-CoV-2 pandemic, healthcare systems around the world observed an increased rate of Acute Limb Ischemia (ALI) in patients with a COVID-19 infection. Despite several pieces of evidence suggesting that COVID-19 infection may also worsen the prognosis associated with ALI, only a small number of published studies include a direct comparison regarding the outcomes of both COVID-19 and non-COVID-19 ALI patients. Based on the above, a systematic review and a meta-analysis of the literature were conducted, evaluating differences in the incidence of two major outcomes (amputation and mortality rate) between patients concurrently affected by COVID-19 and negative ALI subjects. PubMed (MEDLINE), Web of Science, and Embase (OVID) databases were scrutinized from January 2020 up to 31 December 2023, and 7906 total articles were recovered. In total, 11 studies (n: 15,803 subjects) were included in the systematic review, and 10 of them (15,305 patients) were also included in the meta-analysis. Across all the studies, COVID-19-positive ALI patients experienced worse outcomes (mortality rates ranging from 6.7% to 47.2%; amputation rates ranging from 7.0% to 39.1%) compared to non-infected ALI patients (mortality rates ranging from 3.1% to 16.7%; amputation rates ranging from 2.7% to 18%). Similarly, our meta-analysis shows that both the amputation rate (OR: 2.31; 95% CI: 1.68–3.17; p < 0.00001) and mortality (OR: 3.64; 95% CI: 3.02–4.39; p < 0.00001) is significantly higher in COVID-19 ALI patients compared to ALI patients.

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Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 93%

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 99%

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 99%

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 99%

Section: Description Of Included Studies In the Systematic Reviewmentioning

confidence: 99%

See 3 more Smart Citations

The Impact of COVID-19 on Amputation and Mortality Rates in Patients with Acute Limb Ischemia: A Systematic Review and Meta-Analysis

Crupi,

Ardizzone,

Calapai

et al. 2024

Diseases

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Re-do Hybrid Deep Venous Arterialization via the Popliteal Venous System: Conversion From a Deep Venous Arterialization to a Superficial Venous Arterialization

Malkoc,

GnanaDev,

Kim

et al. 2024

Vasc Endovascular Surg

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Deep venous arterialization (DVA) is a final option for limb salvage in patients with end stage arterial anatomy. We report a 66-year-old dialysis dependent male with forefoot gangrene, Rutherford class 6 chronic limb ischemia, who required a redo endovascular DVA. On initial presentation an angiogram was demonstrated a desert foot with absent tibial runoff to his bilateral lower extremities. After discussion, patient elected to trial DVA in hope of avoiding a major amputation. A hybrid DVA was performed using a Pioneer Plus and .018″ Viabahn stents from the peroneal artery into the peroneal venous system; following this, the peroneal vein was anastomosed to the lesser saphenous vein via an open posterior approach at the ankle. 3 months later, a second DVA was performed by exposing the above knee popliteal artery and vein and creating an end-to-side anastomosis. Of note, the great saphenous vein was less than 2 mm in diameter and no arm vein was available due to history of prior fistulas in bilateral arms. Via the popliteal vein, the posterior tibial vein was selected and additional .018″ Viabahn stents were deployed from the malleolus to the P2 segment of the popliteal vein. Three months after the second hybrid DVA, the patient’s forefoot had healed after split thickness skin grafting. Continued patency is noted of the re-do hybrid DVA with minimal calf edema. Newer creative strategies are required for “No Option Chronic Limb Ischemia” which is becoming more relevant in diabetic and dialysis dependent patients. This case illustrates the potential to convert a deep venous arterialization to a superficial venous arterialization for improved venous outflow and wound healing.

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The association between mortality due to COVID-19 and coagulative parameters: a systematic review and meta-analysis study

Abdollahi,

Nateghi,

Panahi

et al. 2024

BMC Infect Dis

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Aims and objectives This systematic review and meta-analysis study evaluated the association between mortality due to COVID-19 and coagulative factors. Methods A systematic search was conducted on electronic databases including PubMed, Scopus, and the Web of Science from the beginning of the pandemic until October 2024 to identify relevant studies on COVID-19 patients and their laboratory findings related to coagulation markers and mortality outcome. Eligibility criteria were defined based on the PICO framework, and data extraction was performed by two authors independently using a standardized sheet. Statistical analysis was accomplished using the random effects model, and heterogeneity among studies was assessed using the I 2 test. R and RStudio were used for statistical analysis and visualization. Results Our systematic literature search yielded 6969 studies, with 48 studies meeting the inclusion criteria for our meta-analysis. The mean platelet count was significantly lower in deceased COVID-19 patients compared to survivors (20.58), while activated partial thromboplastin time (aPTT) and fibrinogen levels did not show significant differences. The pooled mean difference of D-Dimer, International Normalized Ratio (INR), and prothrombin time (PT) were significantly lower in survived patients (-2.45, -0.10, and -0.84, respectively). These findings suggest that platelet count, D-Dimer, INR, and PT may serve as potential indicators of mortality in COVID-19 patients. Conclusion The results of our systematic review and meta-analysis revealed a significant reduction in the pooled platelet count among deceased individuals when compared to survivors. However, no significant distinctions were observed in the pooled mean activated aPTT and fibrinogen levels between the deceased and survivor groups. On the other hand, there were noticeable variations in the pooled estimated mean of INR, PT, and D-Dimer levels, with significantly higher values in the deceased group compared to those who survived. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-024-10229-y.

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A Comparative Analysis of Critical Limb Ischemia in the Intensive Care Unit since the COVID-19 Pandemic

Cited by 3 publications

References 18 publications

The Impact of COVID-19 on Amputation and Mortality Rates in Patients with Acute Limb Ischemia: A Systematic Review and Meta-Analysis

The Impact of COVID-19 on Amputation and Mortality Rates in Patients with Acute Limb Ischemia: A Systematic Review and Meta-Analysis

Re-do Hybrid Deep Venous Arterialization via the Popliteal Venous System: Conversion From a Deep Venous Arterialization to a Superficial Venous Arterialization

The association between mortality due to COVID-19 and coagulative parameters: a systematic review and meta-analysis study

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