Urgent vascular surgery in a COVID-19 hospital

Objective. To study the results of treatment of acute vascular diseases in COVID-19 patients compared to previous period. Material and methods. A prospective single-center study included 236 COVID-19 patients with acute arterial and venous thrombosis between April 01, 2020 and October 18, 2020. These patients were included in group 1. The control group was formed from patients (n=160) with emergency vascular diseases for the period from April 01, 2019 to October 18, 2019. Analyzing clinical and anatomical characteristics of groups, we should emphasize more severe clinical status of patients with COVID-19. Mean age of patients increased by 5 years (p=0.09). Acute coronary syndrome (p=0.03), chronic obstructive pulmonary disease (p=0.03), chronic renal failure (p=0.0007), chronic lower limb ischemia grade ≥IIB (p=0.004) and reduced LV ejection fraction (p=0.04) were more common. All patients in this sample were diagnosed with community-acquired bilateral viral pneumonia and significant decrease in blood oxygen saturation (SpO2) to 90.3±4.8% (p=0.01), lung damage 63.4±18.1% and the need for mechanical ventilation in every fifth patient. EuroSCORE II was 9.9±1.1 that was significantly higher compared to the control group (p=0.02). Results. When analyzing acute vascular pathology in COVID-19 patients, we should note more common deep vein thrombosis of the lower extremities (p=0.0008), deep vein thrombosis of the upper extremities (p=0.03), thrombosis of femoropopliteal arteries (p=0.01). Thrombosis of superficial veins of the upper and lower extremities was less common. Despite high incidence of acute arterial thrombosis of the lower extremities, the number of thrombectomies was the same (p=0.03). This is largely due to increase in the number of amputations (4 times) for irreversible ischemia. The number of crossectomies significantly decreased due to less number of patients with thrombophlebitis of great saphenous vein (p=0.02). Incidence of other interventions did not change. In-hospital mortality was 2-fold higher in COVID-19 patients (group 1: 54.2%, n=13; group 2: 25%, n=2; p=0.3; OR 3.54; 95% CI 0.59-21.25). Despite anticoagulation (UFH 5000 U 4 times a day subcutaneously), repeated thrombosis developed in 20.8% (n=5) of cases and requiring repeated trombectomy. An important finding of our study was recurrent thrombosis of the femoropopliteal segment in dead patients. This parameter became significant predictor of adverse cardiovascular events (OR 4.24; 95% CI 1.55-5.21). The cause of recurrent thrombosis was not related to technical errors of primary surgery. Certain preconditions such as distal thrombosis, embolism, detachment of intima or plaque, arterial stenosis, etc. have not been identified. However, surface of the artery undergoing endarterectomy is characterized by provocation of active inflammatory process in this area. In COVID-19, violation of rheological properties of blood and cytokine storm, changes in reconstruction zone are intensified. This can cause early thrombosis. Other risk factors of unfavorable cardiovascular outcome were lung tissue damage ≥60% (OR 3.55; 95% CI 0.66—6.94), SpO2 ≤90% (OR 4.78; 95% CI 1.57-5.86); AUC was 0.671 Conclusion. In the context of COVID-19, incidence of peripheral arterial thrombosis following atherosclerosis and pathophysiological changes in hemostatic system has increased. This increased the number of amputations and thrombectomies. Repeated thrombectomy along with low saturation and extensive lung damage was characterized by high risk of cardiovascular complications.