Single center vascular Hub experience after 7 weeks of COVID-19 pandemic in Lombardy (Italy)

Mascia, Daniele; Kahlberg, Andrea; Melloni, Andrea; Rinaldi, Enrico; Melissano, Germano; Chiesa, Roberto

AIM: to report the experience of one of the major “Hubs” for Vascular Surgery in Lombardy, Italy, during the first 7 weeks after total lockdown due to COVID-19 pandemic. METHODS: data from all patients treated at our Department since the decision of the regional healthcare authorities of Lombardy to centralize surgical specialties creating a Hub/Spoke system (March, 9, 2020) were prospectively collected and compared with a retrospectively collected cohort from the same period of year 2019 . Primary study end point was defined as primary clinical success. Secondary endpoints were defined as in-hospital mortality and/or any in hospital major adverse event (MAE) or lower limb amputation. RESULTS: one hundred and sixteen patients were treated (81 men, 70%; median age: 71 years, IQR 65-81). Thirty-two patients (28%) were addressed from Spoke hospitals directly referring to our Hub, 19 (16%) from hospitals belonging to other Hub/Spoke nets, 48 (41%) came directly from our Emergency Department, and 17 (15%) were already hospitalized for COVID-19 pneumonia. Acute limb ischemia was the most observed disease, occurring in 31 (26.7%), 12 (38.7%) of whom were found positive for COVID-19 pneumonia on admission, while 3 (9.7%) became positive during hospitalization. Chronic limb ischemia was the indication to treatment in 24 (20.7%) patients. Six (5.2%) patients underwent primary amputation for irreversible ischemia. Aortic emergencies included 21 cases (18.1%), including 13 (61.9%) symptomatic abdominal aortic or iliac aneurysms, 4 (19.0%) thoracoabdominal aortic aneurysms, 2 (9.5%) cases of acute type B aortic dissection (one post-traumatic). Seventeen (14.7%) patients were admitted for symptomatic carotid stenosis (no Covid-19 patients), all of them underwent carotid endarterectomy. Seventeen (14.7%) cases were treated for other vascular emergencies. Overall, at a median follow-up of 23±13 days, primary clinical success was 87.1% and secondary clinical success was 95.9%. We recorded 3 in-hospital deaths for an overall mortality rate of 2.6%. Compared with the 2019 cohort, “COVID era” patients were older (72 vs 63 years, p=.002), more frequently transferred from other hospitals (44% vs 21%, p=.014) and more frequently with decompensated chronic limb threatening ischemia (21% vs 3%, p=.015); surgical outcomes were similar between the two cohorts. CONCLUSIONS: Since its appearance, SARS-CoV-2 has been testing all national health systems which founds themselves having to face an unprecedented emergency. Late referral in the pandemic period could seriously worsen limb prognosis, this aspect should be known and addressed by healthcare providers. Vascular surgical outcomes in pre-COVID and COVID-era were comparable in our experience.