ACUTE ARTERIAL AND DEEP VENOUS THROMBOEMBOLISM IN COVID-19 PATIENTS

Bozzani, Antonio; Arici, Vittorio; Tavazzi, Guido; Franciscone, Mila Maria; Danesino, Vittorio; Rota, Monica; Rossini, Rosa; Sterpetti, Antonio V.; Ticozzelli, Giulia; Rumi, Elisa; Mojoli, Francesco; Bruno, Raffaele; Ragni, Franco

INTRODUCTION: The Lombardy region (Italy) suffered severe problems during the acute phase of the outbreak of COVID-19 in Italy (March-April 2020) with 16,000 diagnosed COVID-19 related deaths (49% of the total COVID-19 related deaths in Italy). In the area surrounding Pavia during the critical stage of the outbreak (March-April), 1,225 of the documented 4,200 deaths were related to COVID-19 infection, with a mortality rate of 181/100,000 inhabitants and an increase in deaths of 138% compared to the same period in previous years. AIM: Our aim was to report the experience of the Department of Vascular Surgery of Pavia (Lombardy), including the lessons learned and future perspectives regarding the management of COVID-19 patients who developed severe acute ischemia with impending lower limb loss or deep vein thrombosis (DVT). MATERIALS AND METHODS: We carried out a retrospective data collection of COVID-19 patients with severe acute ischemia of the lower limbs or DVT observed in our Department during the period March 1(st) to April 30(th) 2020. Primary outcomes of the analysis were postoperative mortality for all patients and amputation rates only in those COVID-19 patients suffering from acute lower limb ischemia. Secondary outcomes were the prevalence of the disease among admitted COVID-19 patients, and any possible correlation between inflammatory parameters, thrombolytic status, and the presence of acute ischemia or DVT. RESULTS: We observed 38 patients (28 male) with severe COVID-19 infection (6 with lower limb arterial thrombosis and 32 with DVT). The median age was 64 years (range 30-94 years). In the arterial group, 3 had thrombosis on plaque and 3 on healthy arteries ("simple" arterial thrombosis). All underwent operative or hybrid (open/endo) revascularization; 1 patient died from major organ failure (MOF) and one patient underwent major amputation. In the DVT group, 9 (28%) patients died from MOF, despite aggressive medical therapy. In patients with "simple" arterial thrombosis and those with DVT, we observed a decrease in inflammatory parameters (CRP) and in D-dimer and fibrinogen after aggressive therapy (p <0.001). CONCLUSIONS: Our study confirms that critically ill, COVID-19 patients who develop arterial and deep vein thrombosis are at high risk of mortality, but if treated properly, there is an improvement in overall survival rate, especially in patients of 60 years of age or younger.