Triage of patients with venous and lymphatic diseases during the COVID-19 pandemic – The Venous and Lymphatic Triage and Acuity Scale (VELTAS)

Abstract

<jats:p> The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30–90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6–12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions. </jats:p>

COVID-19 related thrombosis: A mini-review

“…Due to scarcity of resources, the International Union of Phlebology in conjunction with the Australasian College of Phlebology initiated the Venous and Lymphatic Triage and Acuity Scale (VELTAS) to triage patients with VTE into different urgency levels to be treated. 77 It serves as a general guideline for patients diagnosed with VTE, not limited to those with COVID-19. Patients with different clinical diagnosis are classified into “medical emergency,” “urgent,” “semi-urgent,” and “non-urgent.” 77 Those with massive PE, acute iliofermoral DVT with phlegmasia, acute central vein thrombosis with superior vena cava syndrome, or venous gangrene should be attended “immediately.” While others with chronic venous obstructive symptoms or those who are stable and asymptomatic may be seen less urgently.…”

“… 77 It serves as a general guideline for patients diagnosed with VTE, not limited to those with COVID-19. Patients with different clinical diagnosis are classified into “medical emergency,” “urgent,” “semi-urgent,” and “non-urgent.” 77 Those with massive PE, acute iliofermoral DVT with phlegmasia, acute central vein thrombosis with superior vena cava syndrome, or venous gangrene should be attended “immediately.” While others with chronic venous obstructive symptoms or those who are stable and asymptomatic may be seen less urgently.…”

“…Due to scarcity of resources, the International Union of Phlebology in conjunction with the Australasian College of Phlebology initiated the Venous and Lymphatic Triage and Acuity Scale (VELTAS) to triage patients with VTE into different urgency levels to be treated. 77 It serves as a general guideline for patients diagnosed with VTE, not limited to those with COVID-19. Patients with different clinical diagnosis are classified into "medical emergency," "urgent," "semi-urgent," and "non-urgent."…”

Evaluation der Versorgungsituation von Patient*innen mit chronischen Lymphödemen während der COVID-19-Pandemie

“…Alternative nicht als ersetzende, sondern additive Option gesehen werden [19]. Insbesondere bei besonders komplexen Fällen sollte die persönliche Vorstellung präferiert werden [2,9,20,21,22]. Hierzu zählen Entzündungen, rezidivierende Erysipele, stark volumenschwankende Ödeme sowie das Lymphödem Stadium III.…”

Impact of COVID-19 on aortic operations

“…Its catastrophic consequences on health has impacted all aspects of medical practice—from the availability of, and accessibility to, health services, to patients’ disease management, to outpatients’ cures, to the ease of invasive treatments, among others. Regarding vascular surgery services and procedures, all types of surgical or endovascular interventions are in a mutable state, dictated by COVID-19–related priorities [2] , [3] , [4] , [5] . Patients with COVID-19, both young and old, experience vascular complications, such as arterial and venous thromboembolic disease, which are increased by infectious and multiorgan failure status [6] .…”