Update of the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia in Light of the COVID-19 Pandemic, Based on a Scoping Review of the Literature

Jongkind, Vincent; Earnshaw, J.J.; Gonçalves, Frederico Bastos; Cochennec, F.; Debus, E.S.; Hinchliffe, R.; Menyhei, G.; Svetlikov, A.V.; Tshomba, Y.; Berg, Jos C. van den; Björck, Martin

doi:10.1016/j.jvs.2021.12.019

Cited by 3 publications

(4 citation statements)

References 39 publications

(66 reference statements)

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“…In our study, we were able to assess the rapid evolution of these patients towards irreversible ischaemia, which led to amputation as a therapeutic measure in 37% of cases. In a study by Bellosta R. et al 9 , the success of revascularisation was low in patients with Covid-19 compared to patients in previous reported series. This is thought to be due to the impossibility of obtaining effective distal revascularisation and recurrent episodes of thrombosis of the treated segments, which led to a change in their treatment protocol to include a more aggressive regimen with thrombolysis and continuous heparin infusion 10 .…”

Section: Discussionmentioning

confidence: 81%

“…This was observed in follow-up studies by Perini P. et al 8 , where they reported two cases of critical limb ischaemia in young patients with Covid-19 and no comorbidities with a characteristic aggressive presentation. As in the systematic review of the European Society for Vascular Surgery, it was identified that critical limb ischaemia during the pandemic affects younger people with fewer comorbidities with worse outcomes compared to patients without COVID-19 as well as heparin resistance has been observed more frequently 9 .…”

Section: Discussionmentioning

confidence: 99%

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Surgical clinical characteristics of acute arterial thrombosis of the extremities in the context of SAR S-CoV-2 infection

Oca-Hernández¹,

Sierra-Juárez²,

Hernández-Solís³

2022

HGMX

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Objective: To determine the clinical-surgical features of critical limb ischaemia (CLI) within the context of infection by SARS-CoV-2. Methods: Cross-sectional, retrospective, observational, descriptive study, with clinical data obtained from printed and electronic records of patients with CLI treated by the Angiology and Vascular Surgery Service of the General Hospital of Mexico in the period between January 2020 and July 2021. Results: We evaluated the data of 33 patients with critical limb ischaemia of which 15 were positive for SARS-CoV-2 in the period from January 2020 to July 2021, females were the most affected representing the 53.3% of the total, patients under 60 years old accounted for 26.67%. Twenty-six percent of the patients presented critical limb ischaemia without having previous comorbidities, 60% of these presented with an advanced state of the disease and a delay in specialised medical care of more than 6 hours after the onset of symptoms, which warranted a major amputation in 37% of cases, the lower extremities represented 90% of the affected anatomical regions. Conclusions: the outcomes in our study show that the incidence of critical limb ischaemia during the SARS-CoV2 pandemic period occurred in an atypical way in a segment of young patients and without known event-generating comorbidities. Thromboembolic events, probably associated with the hypercoagulable state generated by this infection, also evolved rapidly and aggressively from the onset of symptoms despite prompt treatment.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Surgical clinical characteristics of acute arterial thrombosis of the extremities in the context of SAR S-CoV-2 infection

Oca-Hernández¹,

Sierra-Juárez²,

Hernández-Solís³

2022

HGMX

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“…Secondly, a larger inclusion of vascular diagnoses and a more precise description of the procedures performed would be necessary to clarify the real economic impact of Cov-ES in our Vascular unit. Moreover, our retrospective analysis of patients was focused on 2019-2020 and impeded the evaluation of the effects of the last update guidelines on the management of the cardiovascular disease and acute limb ischemia 21 , 22 . Lastly, this analysis included data from a single Italian regional hospital, which has economical roles slightly different from other regional centres, as described above, and a comparison between different regional hospitals would be interesting to understand if our data were in line with the national average.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Economic Impact of COVID-19 in Vascular Surgery at a Tertiary University “Hub” Hospital of Italy

Veraldi

Mezzetto

Perilli

et al. 2022

Annals of Vascular Surgery

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“…One could make an argument for rapid COVID-19 testing for any patient presenting during the pandemic with an acutely ischaemic limb, but treatment should not be delayed and appropriate infection control precautions should be used [52]. There has been a suggestion that regional or neuraxial anaesthesia may be the preferred technique for those with COVID-19 (reducing concerns over airway manipulation) [53].…”

Section: Acute Ischaemic Limbmentioning

confidence: 99%

Anaesthesia for vascular emergencies – a state of the art review

et al. 2022

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Summary In this state‐of‐the‐art review, we discuss the presenting symptoms and management strategies for vascular emergencies. Although vascular emergencies are best treated at a vascular surgical centre, patients may present to any emergency department and may require both immediate management and safe transport to a vascular centre. We describe the surgical and anaesthetic considerations for management of aortic dissection, aortic rupture, carotid endarterectomy, acute limb ischaemia and mesenteric ischaemia. Important issues to consider in aortic dissection are extent of the dissection and surgical need for bypasses in addition to endovascular repair. From an anaesthetist's perspective, aortic dissection requires infrastructure for massive transfusion, smooth management should an endovascular procedure require conversion to an open procedure, haemodynamic manipulation during stent deployment and prevention of spinal cord ischaemia. Principles in management of aortic rupture, whether open or endovascular treatment is chosen, include immediate transfer to a vascular care centre; minimising haemodynamic changes to reduce aortic shear stress; permissive hypotension in the pre‐operative period; and initiation of massive transfusion protocol. Carotid endarterectomy for carotid stenosis is managed with general or regional techniques, and anaesthetists must be prepared to manage haemodynamic, neurological and airway issues peri‐operatively. Acute limb ischaemia is a result of embolism, thrombosis, dissection or trauma, and may be treated with open repair or embolectomy, under either general or local anaesthesia. Due to hypercoagulability, there may be higher numbers of acutely ischaemic limbs among patients with COVID‐19, which is important to consider in the current pandemic. Mesenteric ischaemia is a rare vascular emergency, but it is challenging to diagnose and associated with high morbidity and mortality. Several peri‐operative issues are common to all vascular emergencies: acute renal injury; management of transfusion; need for heparinisation and reversal; and challenging postoperative care. Finally, the important development of endovascular techniques for repair in many vascular emergencies has improved care, and the availability of transoesophageal echocardiography has improved monitoring as well as aids in surgical placement of endovascular grafts and for post‐procedural evaluation.

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Update of the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia in Light of the COVID-19 Pandemic, Based on a Scoping Review of the Literature

Cited by 3 publications

References 39 publications

Surgical clinical characteristics of acute arterial thrombosis of the extremities in the context of SAR S-CoV-2 infection

Surgical clinical characteristics of acute arterial thrombosis of the extremities in the context of SAR S-CoV-2 infection

Clinical and Economic Impact of COVID-19 in Vascular Surgery at a Tertiary University “Hub” Hospital of Italy

Anaesthesia for vascular emergencies – a state of the art review

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