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.
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.
Background: In many facilities, the coronavirus disease (COVID-19) pandemic caused suspension of elective surgery. We therefore sought to determine the impact of this on the surgical experience of vascular trainees. Methods: Surgical case volume, breadth, and the participating trainee post-graduate level from 3 large New York City Hospitals with integrated residency and fellowship programs (Mount Sinai, Montefiore Medical Center/Albert Einstein College of Medicine, and New York University) were reviewed. Procedures performed between February 26 to March 25, 2020 (pre-pandemic month) and March 26 to April 25, 2020 (peak pandemic period) were compared to those performed during the same time period in 2019. The trainees from these programs were also sent surveys to evaluate their subjective experience during this time. Results: The total number of cases during the month leading into the peak pandemic period was 635 cases in 2019 and 560 cases in 2020 (12% decrease). During the peak pandemic period, case volume decreased from 445 in 2019 to 114 in 2020 (74% reduction). The highest volume procedures during the peak pandemic month in 2020 were amputations and peripheral cases for acute limb ischemia; during the 2019 period, the most common cases were therapeutic endovascular procedures. There was a decrease in case volume for vascular senior residents of 77% and vascular junior and midlevel residents of 75%. There was a 77% survey response rate with 50% of respondents in the senior years of training. Overall, 20% of respondents expressed concern about completing ACGME requirements due to the COVID-19 pandemic. Conclusions: Vascular surgery-specific clinical educational and operative experiences during redeployment efforts have been limited. Further efforts should be directed to quantify the impact on training and to evaluate the efficacy of training supplements such as teleconferences and simulation.
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