The Evolution of COVID-19 Associated Vascular Complications from 2020 to 2022

Abstract

Vascular thrombotic events are prominent in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A meta-analysis of 64,503 hospitalized SARS-CoV-2 patients showed deep vein thrombosis in 11.2% and pulmonary embolism 7.8%. One study screening for venous thromboembolism reported a 25% incidence. Vascular thrombosis was reported as an independent risk factor for mortality in SARS-CoV-2. Acute limb ischemia was reported in 0.3% to 1.0% of hospitalized patients, predominantly male, and 18% of these patients suffered limb loss. We observed vascular complications in SARS-CoV-2 has changed from 2020. This study compared venous and arterial thromboembolism during the early stages of the pandemic to the present. Patients with confirmed SARS-CoV-2 between December 2019 and April 2022 and treated with an arterial/venous thromboembolic event at a major metropolitan hospital were reviewed retrospectively. We found 68 patients found to have either venous thromboembolism or an arterial thromboembolism, 45 in 2020 and 23 after 2020. Mean age of all patients 60.8 ± 4.2 years (range, 32-92 years). Mean age in 2020 was 62.8 ± 16.3 years (range, 36-92 years) and the mean age of those after 2020 was 56.9 ± 13.4 years (range, 32-87 years). Overall, 38 patients were male and 30 female. In 2020, there were 31 males and 14 females. After 2020, we identified 7 males and 16 females. Overall, 56 vessels involved were in lower extremity and 12 in upper extremity. In 2020, 34 vessels involved were in lower extremity and 11 in upper extremity. After 2020, 22 vessels involved were in lower extremity and 1 in upper extremity. Overall, 31 thrombosis were venous and 37 were arterial. In 2020, 9 were venous and 36 arterial thrombosis. After 2020, 22 were venous and 1 arterial thrombosis. Overall, 39 required surgical interventions. In 2020, 29 underwent surgical interventions. After 2020, 10 underwent surgical interventions (all venous). Overall, 59 patients were discharged and 9 expired. In 2020, 36 were discharged and 9 expired. After 2020, all 23 were discharged. Vascular complications are a common manifestation of SARS-CoV-2 infection. Early in the pandemic, most vascular complications were acute, occurred primarily in arteries, required major emergency interventions and amputations, and were associated with high mortality. As the pandemic evolved, observed vascular complications were less acute, more indolent, and less catastrophic, affected mostly veins, required less urgent interventions, or treated with just observation, and associated with low mortality. The vascular complications associated with SARS-CoV-2 infection have changed from the early pandemic to present. The long-term vascular effects of SARS-CoV-2 is unknown.