EP.WE.561The impact of COVID-19 on infra-inguinal revascularisation in patients with symptomatic peripheral occlusive arterial disease

Abstract

IntroductionStandard Operating Procedures were revised in response to the Covid-19 pandemic. There are descriptions from across Europe of increased rates of major extremity amputation. We have explored practice in a regional vascular unit serving two Health Boards in Scotland with specific reference to infra-inguinal revascularisation for patients with symptomatic peripheral occlusive arterial disease.MethodsA retrospective review of the administrative theatre database was performed. Pre-Covid (1st April–July 31st 2019) and peri-Covid (1st April-31st July 2020) periods were examined and index cases identified. Practice and outcomes were examined.ResultsThere was a 50% reduction in scheduled theatre sessions during the peri-Covid period. There were 100 procedures performed pre-Covid and 71 procedures performed during the peri-Covid period. The patient demographics were comparable – mean age 68-years with a male to female ratio of 1.6:1. Intervention for chronic limb threatening ischaemia was much more common in the peri-Covid period than in the pre-Covid period (94% versus 64% respectively). There was a clear change in anaesthetic practice with regional anaesthesia more commonly performed in the peri-Covid period (49% versus 12% respectively). There was no difference in the types of revascularisation performed. The 30-day mortality in the peri-Covid period was less than in the pre-Covid period (3% vs 1.4%).ConclusionThe Covid-19 pandemic created imperatives that necessitated re-structure of service. Despite a reduction in theatre access we have managed to maintain a limb salvage service for patients with chronic limb threatening ischaemia.