Impact of COVID-19 Pandemic on Clinical Care of Peripheral Arterial Disease Patients: A Single-Center Experience

Abstract

Objective: To better manage the burden of the COVID-19 pandemic on hospitals, numerous scheduled procedures have been postponed nationwide. Design and Methods: Retrospective analysis of patient characteristics and outcomes of patients hospitalized with peripheral arterial disease (PAD) in the period prior to the COVID-19 pandemic (2018 and 2019) and during the pandemic (2020 and 2021). This study assesses the in-hospital outcomes. Main endpoints are Rutherford stages at admission for intervention, incidence of amputation, of total occlusion, and duration of intervention. The data were analyzed descriptively. Results: The total number of interventions due to PAD had decreased in 2020, but not significantly during the pandemic period (n = 5351) compared to the period prior to COVID-19 pandemic (n = 5351) (p = 0.589). The proportion of interventions treated for critical limb-threatening ischaemia (CLTI) increased from 2018/2019 (n = 2112) to 2020/2021 (n = 2426) (p < 0.001). However, the proportion of patients with wounds requiring amputation was not higher during the pandemic (n = 191) than before (n = 176) (minor amputations p = 0.2302, major amputations p = 0.9803). The proportion of total occlusions did not differ significantly between the pre-COVID-19 (n = 3082) and the COVID-19 pandemic periods (n = 2996) (p = 0.8207). Multilevel interventions did not increase significantly from 2018/2019 (n = 1930) to 2020/2021 (n = 2071). Between 2018/2019 and 2020/2021, the procedure duration and fluoroscopy duration increased significantly. However, parameters such as contrast agent volume and radiation dose did not differ significantly. The average length of stay was 4.6 days. Conclusion: The COVID-19 pandemic had an impact on the in-patient care of PAD patients in terms of disease stage severity and complexity. However, the amputation rate was not affected.

The indirect impact of COVID‐19 pandemic on limb preservation care– a retrospective analysis of trends in lower limb revascularisation

“…However, many of these studies only evaluated the first wave of the pandemic therefore a potential increase in numbers due to delayed presentations and referrals cannot be excluded. One study has evaluated the long-term impact of the pandemic on PAD and found similar results of increased revascularisations during the pandemic [9]. Despite an increase in revascularisation procedures likely indicating a deterioration of PAD during the pandemic, this study did not find any statistically significant increases in toe, forefoot or below knee amputations during the pandemic compared to pre-pandemic times.…”

“…This reduction in follow-up most likely contributed in a significant way to the deterioration of PAD in these patients which eventually lead to them requiring more revascularisation procedures during the pandemic. Indeed a few studies report that patients who presented to hospital with PAD during the pandemic had more severe disease on average compared to pre-pandemic times and required more advanced interventions or even amputations [9][10][11][12]. Another contributing factor to the increase in revascularisations during the pandemic is a general decline in patient health during the pandemic.…”

“…In terms of trends in procedure volume with respect to lockdown periods, this study found a decline in revascularisation procedures during lockdown periods lasting over 30 days, however, over the longer term, there was an overall increase in revascularisation procedures performed during the pandemic. Previous studies have noted a decline in vascular surgery procedures during the pandemic compared to pre‐pandemic times, but none have investigated the correlation between procedure volume and lockdown periods or the nature of lockdowns [9–12]. Future studies analysing this correlation could aid in developing lockdown strategies that minimise disruptions to healthcare services.…”

“…Another study from Romania showed a significant decrease in non-urgent vascular surgery during the pandemic [8]. Other studies have also reported that patients with PAD who presented to hospital during the pandemic, often presented with severe disease compared to pre-pandemic times and required more extensive revascularisations [9][10][11][12]. These studies have mainly focused on the first wave of the pandemic.…”

The indirect impact of COVID-19 pandemic on limb preservation care– a retrospective analysis of trends in lower limb revascularisation

“…This reduction in follow-up most likely contributed in a signi cant way to the deterioration of PAD in these patients which eventually lead to them requiring more revascularisation procedures during the pandemic. Indeed a few studies report that patients who presented to hospital with PAD during the pandemic had more severe disease on average compared to pre-pandemic times and required more advanced interventions or even amputations (9)(10)(11)(12).…”