Abstract
ObjectiveTo perform a scoping review of how patients with COVID-19 are affected by acute limb ischaemia (ALI) and evaluate the recommendations of the 2020 ESVS ALI Guidelines for these patients.MethodsResearch questions were defined, and a systematic literature search was performed following the PRISMA guidelines. s and unpublished literature were not included. The definition of ALI in this review is in accordance with the ESVS guidelines.ResultsMost identified papers were case reports or case series, although population based data and data from randomised controlled trials were also identified. In total, 114 unique and relevant papers were retrieved. Data were conflicting concerning whether the incidence of ALI increased, or remained unchanged, during the pandemic. Case reports and series reported ALI in patients who were younger and healthier than usual, with a greater proportion affecting the upper limb. Whether or not this is coincidental remains uncertain. The proportion of men/women affected seems unchanged. Most reported cases were in hospitalised patients with severe COVID-19. Patients with ALI as their first manifestation of COVID-19 were reported. Patients with ALI have a worse outcome if they have a simultaneous COVID-19 infection. High levels of D-dimer may predict the occurrence of arterial thromboembolic events in patients with COVID-19. Heparin resistance was observed. Anticoagulation should be given to hospitalised COVID-19 patients in prophylactic dosage. Most of the treatment recommendations from the ESVS Guidelines remained relevant, but the following were modified regarding patients with COVID-19 and ALI: 1) CTA imaging before revascularisation should include the entire aorta and iliac arteries; 2) there should be a high index of suspicion, early testing for COVID-19 infection and protective measures are advised; and 3) there should be preferential use of local or locoregional anaesthesia during revascularisation.ConclusionAlthough the epidemiology of ALI has changed during the pandemic, the recommendations of the ESVS ALI Guidelines remain valid. The above mentioned minor modifications should be considered in patients with COVID-19 and ALI.
Highlights
In February 2020 the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia (ALI) were published.[1]
There were 89 case reports or small series (n < 10), one randomised controlled trial (RCT), three systematic reviews, and nine cohort studies reporting on 13 e 49 patients with ALI associated with COVID-19
Other included studies included cohort studies only on incidence or mortality of ALI associated with COVID-19, or review of organisation of care for ALI during the pandemic
Summary
In February 2020 the European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia (ALI) were published.[1] They were the first ever guidelines to be published focusing on how to treat patients with ALI, irrespective of aetiology. The publication of this document coincided with the start of the COVID-19 pandemic, and was timely, as both venous and arterial thrombosis have been recognised as important manifestations of the disease.[2,3] In April 2020 the editors of this journal made an early call for research initiatives linked to the pandemic.[4] One important question is whether the diagnostic and management recommendations issued in the ALI Guidelines are applicable to a patient who develops ALI as a manifestation of COVID-19, or if the recommendations require adjustment. It is important to try to understand how the pandemic has affected the epidemiology of ALI. It was difficult for the writing committee (WC) to perform this analysis at the very beginning of the pandemic, as there were not enough data, and only personal observations and case reports were available
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