A scoping review on the changes in vascular surgical practice during the early phases of the COVID-19 pandemic

Abstract

Objective : The COVID-19 pandemic has had a profound effect on the delivery of vascular surgery to patients around the world. In order to conserve resources and reduce the risk of COVID-19 infection, many institutions have postponed or cancelled surgeries. In this scoping review, we aim to review current literature and recapitulate the significant changes in elective and emergency vascular surgery during the COVID-19 pandemic. Methods : We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. We included all articles that had reported the effects of the COVID-19 pandemic on elective or emergency vascular surgery. Results : A total of 28 articles were included in this scoping review. We identified eight distinct themes that were relevant to our study topic. We report global, regional and local data on vascular surgical cases. We also discuss the adoption of vascular surgery triage systems, emergence of global collaborative vascular surgery research groups, increased use of endovascular techniques and locoregional anaesthesia, delayed presentation of vascular surgery conditions and poorer outcomes of patients with chronic limb-threatening ischaemia. Conclusions : This scoping review provides a snapshot of the impact of the COVID-19 pandemic on elective and emergency vascular surgery.

Impact of the COVID-19 Pandemic on the Diagnosis and Management of Non-Melanoma Skin Cancer in the Head and Neck Region: A Retrospective Cohort Study

“…In this context, ensuring that the procedure is performed by experienced physicians can minimize the incidence of failed blocks and the use of long-acting local anesthetics can prolong the anesthetic effect, enhancing patient safety and comfort. As reported in a recent systematic review, the pandemic has necessitated the modification of preoperative evaluations and the establishment of comprehensive perioperative care strategies, including the prioritization of LA where feasible [37]. This approach not only benefits patients by minimizing potential complications but also plays a critical role in protecting healthcare personnel from exposure to the virus.…”

The state of vascular surgery education in the United States

“…Another survey showed that 49% of first- and second-year medical students will strongly consider vascular surgery as a career if they get exposed to the field and an additional 19% would consider vascular surgery as a career if the length of the training was reduced ( 6 ). Purported case discussions are highly regarded for their ability to simulate real-life scenarios and challenge students' critical thinking skills, with 77.6% of medical students agreeing that they preferred this method of teaching ( 10 ). However, despite the evident preference for hands-on experiences, vascular surgeons contribute minimally to medical school curricula, constituting only 0.2% of lecture hours.…”

“…Similarly teaching medical students how to auscultate for a carotid bruit and how to examine abdomen to palpate prominent aortic pulsations will go a long way to diagnose carotid stenosis and abdominal aortic aneurysms. In a study by Hirsch et al where 83% of patients had a known diagnosis of PAD only 49% of primary care physicians were able to identify this diagnosis ( 10 ). The inability of primary care physicians to identify patients with PAD leads to delayed referrals and advanced stage of presentation to a specialist which can affect surgical outcomes.…”

Editor's Choice – Outcomes of Surgery for Patients with Peripheral Arterial Disease During the COVID-19 Pandemic in the United Kingdom: A Population Based Study

“…4 Changes in the provision of vascular services in response to the pandemic have been documented through surveys of healthcare professionals and institutional reviews. [5][6][7] J o u r n a l P r e -p r o o f 4 Outcomes such as post-operative complications and mortality after vascular interventions during the COVID-19 pandemic have also been explored in the COvid-19 Vascular sERvice (COVER) Tier 2 multicentre study, 8 the COVID-VAS study, 9 as well as other single centre and registry studies. [10][11][12][13] However, most studies had a small sample of patients and focused on the first wave of the pandemic that started in March 2020, and did not extend to late 2020 and 2021.…”