Adapting Vascular Surgery Practice to the Current COVID-19 Era at a Tertiary Academic Center in Madrid

Abstract

Background: The epidemic potential of coronavirus infection is now a reality. Since the first case detected in late 2019 in China, a fast worldwide expansion confirms it. The vascular patient is at a higher risk of developing a severe form of the disease because of its nature associating several comorbid states, and thus, some vascular surgery communities from many countries have tried to stratify patients into those requiring care during these uncertain times. Methods: This is an observational study describing the current daily vascular surgery practice at one tertiary academic hospital in Madrid region, Spaindone of the most affected regions worldwide due to the COVID-19 outbreak. We analyzed our surgical practice since March 14th when the lockdown was declared up to date, May 14th (2 months). Procedural surgical practice, organizational issues, early outcomes, and all the troubles encountered during this new situation are described. Results: Our department is composed of 10 vascular surgeons and 4 trainees. Surgical practice has been reduced to only urgent care, totaling 50 repairs on 45 patients during the period. Five surgeries were performed on 3 COVID-19-positive patients. Sixty percent were due to critical limb ischemia, 45% of them performed by complete endovascular approach, whereas less than 10% of repairs were aorta related. We were allocated to use a total of 5 surgical rooms in different locations, none our usual, as it was converted into an ICU room while performing 50% of those repairs with unusual nursery staff. Conclusions: The COVID-19 outbreak has dramatically changed our organization and practice in favor of urgent or semiurgent surgical care alone. The lack of in-hospital/ICU beds and changing nursery staff changed the whole availability organization at our hospital and was a key factor in surgical decision-making in some cases.

Is There an Impact of COVID-19 on Admission of Patients to the Emergency Department for Vascular Surgery?

“…With the outbreak of COVID-19, vascular surgery departments had to be reorganized, with the surgical activity restricted to a semielective and urgent basis. 5 , 6 …”

The Impact of COVID-19 on Vascular Surgery Practice: A Systematic Review

“…The high demands of the pandemic upon medical staff and increased usage of ICUs, as well as the lack of standardized protocols, force vascular surgeons to make their own exhaustive assessment of the patient's condition to decide whether to operate or not. 5 Remarkably, the risk-benefit evaluation should include how widespread the local infection is and whether adequate resources are available, identifying those cases where the risk outweighs the benefit. 53 In accordance with our findings, it is highly recommended to begin pharmacological prophylaxis in every COVID-19 patient admitted to the ICU, even in the absence of higher-level evidence such as randomized control trials, because there is sufficient evidence coming from observational studies.…”

“…Furthermore, experts have tried to stratify patients according to their comorbidities into subgroups that require urgent care during the pandemic. 5 This review summarizes currently available information regarding the effects of COVID-19 on some of the most common pathologies addressed by vascular surgeons, including venous thromboembolism (VTE), pulmonary embolism (PE), peripheral arterial disease (PAD), and microangiopathy.…”

Impact of the COVID-19 pandemic on the management of chronic limb-threatening ischemia in Northern Jordan: Case series and literature review

“…The approach taken at our hospital does not reflect CLTI management in other hospitals. For example, a recent analysis from Madrid reveals that during the pandemic, 44% of revascularizations were performed using complete endovascular methods, whereas 39% of them were achieved by complete open revascularization [ 8 ]. The endovascular approach minimizes the need for a multidisciplinary input; additionally, its outcome is generally favorable in terms of morbidity and mortality [ 9 ].…”