Bellosta R, Luzzani L, Natalini G, Pegorer MA, Attisani L, Cossu LG, Ferrandina C, Fossati A, Conti E, Bush RL, Piffaretti G, et al.
Journal of vascular surgery. Date of publication 2020 Apr 29;volume ():.
1. J Vasc Surg. 2020 Apr 29. pii: S0741-5214(20)31080-6. doi:
10.1016/j.jvs.2020.04.483. [Epub ahead of print]
Acute limb ischemia in patients with COVID-19 pneumonia.
Bellosta R(1), Luzzani L(2), Natalini G(3), Pegorer MA(2), Attisani L(2), Cossu
LG(2), Ferrandina C(2), Fossati A(2), Conti E(3), Bush RL(4), Piffaretti G(5).
Author information:
(1)Divisions of Vascular Surgery, Department of Cardiovascular Surgery,
Fondazione Poliambulanza, Brescia, Italy. Electronic address:
raffaello.bellosta@poliambulanza.it.
(2)Divisions of Vascular Surgery, Department of Cardiovascular Surgery,
Fondazione Poliambulanza, Brescia, Italy.
(3)Divisions of Vascular Surgery, Department of Cardiovascular Surgery,
Fondazione Poliambulanza, Brescia, Italy; Anesthesia and Intensive Care,
Department of Cardiovascular Surgery, Fondazione Poliambulanza, Brescia, Italy.
(4)Division of Vascular Surgery, Medicine and Surgery, University of Insubria
School of Medicine and ASST Settelaghi, Varese, Italy.
(5)College of Medicine, University of Houston, Houston, Tex.
Comment in
J Vasc Surg. 2020 Sep;72(3):1152-1153.
OBJECTIVE: The aim of our study was to determine the incidence, characteristics,
and clinical outcomes of patients with the novel coronavirus (COVID-19) infection
who had presented with and been treated for acute limb ischemia (ALI) during the
2020 coronavirus pandemic.
METHODS: We performed a single-center, observational cohort study. The data from
all patients who had tested positive for COVID-19 and had presented with ALI
requiring urgent operative treatment were collected in a prospectively maintained
database. For the present series, successful revascularization of the treated
arterial segment was defined as the absence of early (<30 days) re-occlusion or
major amputation or death within 24 hours. The primary outcomes were successful
revascularization, early (≤30 days) and late (≥30 days) survival, postoperative
(≤30 days) complications, and limb salvage.
RESULTS: We evaluated the data from 20 patients with ALI who were positive for
COVID-19. For the period from January to March, the incidence rate of patients
presenting with ALI in 2020 was significantly greater than that for the same
months in 2019 (23 of 141 [16.3%] vs 3 of 163 [1.8%]; P < .001)]. Of the 20
included patients, 18 were men (90%) and two were women (10%). Their mean age was
75 ± 9 years (range, 62-95 years). All 20 patients already had a diagnosis of
COVID-19 pneumonia. Operative treatment was performed in 17 patients (85%).
Revascularization was successful in 12 of the 17 (70.6%). Although successful
revascularization was not significantly associated with the postoperative use of
intravenous heparin (64.7% vs 83.3%; P = .622), no patient who had received
intravenous heparin required reintervention. Of the 20 patients, eight (40%) had
died in the hospital. The patients who had died were significantly older (81 ±
10 years vs 71 ± 5 years; P = .008). The use of continuous postoperative systemic
heparin infusion was significantly associated with survival (0% vs 57.1%; P =
.042).
CONCLUSIONS: In our preliminary experience, the incidence of ALI has
significantly increased during the COVID-19 pandemic in the Italian Lombardy
region. Successful revascularization was lower than expected, which we believed
was due to a virus-related hypercoagulable state. The use of prolonged systemic
heparin might improve surgical treatment efficacy, limb salvage, and overall
survival.
Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All
rights reserved.
DOI: 10.1016/j.jvs.2020.04.483
PMCID: PMC7188654
PMID: 32360679
