An increased severity of peripheral arterial disease in the COVID-19 era

Sena, Giuseppe; Gallelli, Giuseppe

doi:10.1016/j.jvs.2020.04.489

Cited by 38 publications

(45 citation statements)

References 2 publications

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“…Our results align with other early studies demonstrating increased amputation rates and peripheral artery disease severity in the setting of the COVID-19 pandemic. 8 , 9 Recent publications outside of vascular surgery suggest we are not alone in our observation of negative pandemic-related effects. A recent study found that weekly rates of hospitalization for acute myocardial infarction decreased by 48% during the pandemic, suggesting that emergent patient needs are likely not being addressed.…”

Section: Discussionmentioning

confidence: 97%

Impact of the coronavirus disease 2019 pandemic on an academic vascular practice and a multidisciplinary limb preservation program

Lancaster

Iannuzzi

et al. 2020

Journal of Vascular Surgery

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With the aggressive resource conservation necessary to face the COVID-19 pandemic, vascular surgeons face unique challenges to managing the health of their high-risk patients. Early analysis of patient outcomes following pandemic-related practice changes suggest that patients with chronic limb threatening ischemia (CLTI) have been presenting with more severe foot infections and are more likely to require major limb amputation compared to 6 months prior. As our society and health care system adapt to the new changes required in the post-COVID era, it is critical that we pay special attention to the most vulnerable subsets of patients with vascular disease, particularly those with CLTI and limited access to care.

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Section: Discussionmentioning

confidence: 97%

Impact of the coronavirus disease 2019 pandemic on an academic vascular practice and a multidisciplinary limb preservation program

Lancaster

Iannuzzi

et al. 2020

Journal of Vascular Surgery

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“…Physical examinations were reduced significantly, which may have led to delays in diagnosis and treatment of patients without COVID-19. In line with this, Sena and Galleli (2020) 5 describe a significantly greater number of amputations performed in their surgery department during the COVID-19 lockdown in Italy. In our clinic, all elective surgeries were postponed; only urgent surgical care was delivered.…”

Section: Introductionmentioning

confidence: 83%

“…However, Sena and Galleli (2020) describe the same findings in their study during the lockdown period in Italy. 5 They report 9 amputations during the lockdown period in 2020 compared with 5 amputations in 2019. 5 We recommend further investigation of the reported effects in a multicenter study.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 Lockdown Strategy on Vascular Surgery Practice: More Major Amputations than Usual

Schuivens

Buijs

Winter

et al. 2020

Annals of Vascular Surgery

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Background: The aim of this study is to investigate the impact of the coronavirus disease 2019 (COVID-19) lockdown period on the number and type of vascular procedures performed in the operating theater. Methods: A total of 38 patients who underwent 46 vascular procedures during the lockdown period of March 16th until April 30th, 2020, were included. The control groups consisted of 29 patients in 2019 and 54 patients in 2018 who underwent 36 and 66 vascular procedures, respectively, in the same time period. Data were analyzed using SPSS Statistics. Results: Our study shows that the lockdown during the COVID-19 pandemic resulted in a significant increase in the number of major amputations (42% in 2020 vs. 18% and 15% in 2019 and 2020, respectively; P-value 0.019). Furthermore, we observed a statistically significant difference in the degree of tissue loss as categorized by the Rutherford classification (P-value 0.007). During the lockdown period, patients presented with more extensive ischemic damage when than previous years. We observed no difference in vascular surgical care for patients with an aortic aneurysm. Conclusions: Measurements taken during the lockdown period have a significant effect on noneCOVID-19 vascular patient care, which leads to an increased severe morbidity. In the future, policy makers should be aware of the impact of their measurements on vulnerable patient groups such as those with peripheral arterial occlusive disease. For these patients, medical care should be easily accessible and adequate.

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“…Consistent with these observations, we detected a marked decline in the admission rates for acute limb ischemia during the pandemic. Whether this translates into increased disease severity and worse outcomes as others have suggested [26] will need to be investigated.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

et al. 2020

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Aims The first reports of declining hospital admissions for major cardiovascular emergencies during the COVID-19 pandemic attracted public attention. However, systematic evidence on this subject is sparse. We aimed to investigate the rate of emergent hospital admissions, subsequent invasive treatments and comorbidities during the COVID-19 pandemic in Germany. Methods and results This was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalized for acute myocardial infarction, acute limb ischemia, aortic rupture, stroke or transient ischemic attack (TIA) between January 1, 2019, and May 31, 2020, were included. Admission rates per 100,000 insured, invasive treatments and comorbidities were compared from January-May 2019 (pre-COVID) to January-May 2020 (COVID). A total of 115,720 hospitalizations were included in the current analysis (51.3% females, mean age 72.9 years). Monthly admission rates declined from 78.6/100,000 insured (pre-COVID) to 70.6/100,000 (COVID). The lowest admission rate was observed in April 2020 (61.6/100,000). Administration rates for ST-segment elevation myocardial infarction (7.3-6.6), non-ST-segment elevation myocardial infarction (16.8-14.6), acute limb ischemia (5.1-4.6), stroke (35.0-32.5) and TIA (13.7-11.9) decreased from pre-COVID to COVID. Baseline comorbidities and the percentage of these patients treated with interventional or open-surgical procedures remained similar over time across all entities. In-hospital mortality in hospitalizations for stroke increased from pre-COVID to COVID (8.5-9.8%). Conclusions Admission rates for cardiovascular and cerebrovascular emergencies declined during the pandemic in Germany, while patients' comorbidities and treatment allocations remained unchanged. Further investigation is warranted to identify underlying reasons and potential implications on patients' outcomes. Moritz Seiffert and Fabian J. Brunner share the first authorship.

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An increased severity of peripheral arterial disease in the COVID-19 era

Abstract: Cardiovascular examination should also include peripheral arterial evaluation for COVID-19 patientsThe global impact of coronavirus disease (COVID-19) on vascular surgical services has been initially addressed by Ng et al. 1 This change in how vascular surgery

Cited by 38 publications

References 2 publications

Impact of the coronavirus disease 2019 pandemic on an academic vascular practice and a multidisciplinary limb preservation program

Impact of the coronavirus disease 2019 pandemic on an academic vascular practice and a multidisciplinary limb preservation program

Impact of the COVID-19 Lockdown Strategy on Vascular Surgery Practice: More Major Amputations than Usual

Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

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