Luca Attisani1, Alessandro Pucci2, Giorgio Luoni2, Luca Luzzani2, Matteo A Pegorer2, Alberto M Settembrini3, Daniele Bissacco3, Max V Wohlauer4, Gabriele Piffaretti5, Raffaello Bellosta2. 1. Unit of Vascular and Endovascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy - l.attisani@gmail.com. 2. Unit of Vascular and Endovascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy. 3. Unit of Vascular Surgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 4. Unit of Vascular Surgery, University of Colorado, Denver, CO, USA. 5. Unit of Vascular Surgery, ASST Sette Laghi, Varese, Italy.
Abstract
INTRODUCTION: The main goal of this systematic review was to analyze the outcomes of acute limb ischemia (ALI) in patients suffering from the novel Coronavirus: COVID-19 (SARS-CoV-2). EVIDENCE ACQUISITION: A systematic review on Medline and Embase was conducted up to May 15, 2021. All papers were sorted by abstract and full text by two independent authors. Systematic reviews, commentaries, and studies that did not distinguish status of COVID-19 infection were excluded from review. Patient demographics were recorded along with modality of treatment (endovascular and/or surgical). We analyzed 30-day outcomes, including mortality. Primary outcome was to evaluate clinical characteristic of ALI in patients affected by SARS-CoV-2 in term of location of ischemia, treatment options and 30-day outcomes. EVINDENCE SYNTHESIS: We selected 36 articles with a total of 194 patients. Most patients were male (80%) with a median age of 60 years old. The treatment most used was thromboembolectomy (31% of all surgical interventions). A total of 32 patients (19%) were not submitted to revascularization due to critical status. The rate of technical success was low (68%), and mortality rate was high (35%). CONCLUSIONS: This review confirms that SARS-CoV-2 is associated with a high risk of ALI. Further studies are needed to investigate the association and elucidate potential mechanisms, which may include a hypercoagulable state and hyperactivation of the immune response. Furthermore, management of ALI is not standardized and depends on patient condition and extension of the thrombosed segment. ALI in COVID-19 patients is associated with high risk of failure of revascularization and perioperative mortality.
INTRODUCTION: The main goal of this systematic review was to analyze the outcomes of acute limb ischemia (ALI) in patients suffering from the novel Coronavirus: COVID-19 (SARS-CoV-2). EVIDENCE ACQUISITION: A systematic review on Medline and Embase was conducted up to May 15, 2021. All papers were sorted by abstract and full text by two independent authors. Systematic reviews, commentaries, and studies that did not distinguish status of COVID-19 infection were excluded from review. Patient demographics were recorded along with modality of treatment (endovascular and/or surgical). We analyzed 30-day outcomes, including mortality. Primary outcome was to evaluate clinical characteristic of ALI in patients affected by SARS-CoV-2 in term of location of ischemia, treatment options and 30-day outcomes. EVINDENCE SYNTHESIS: We selected 36 articles with a total of 194 patients. Most patients were male (80%) with a median age of 60 years old. The treatment most used was thromboembolectomy (31% of all surgical interventions). A total of 32 patients (19%) were not submitted to revascularization due to critical status. The rate of technical success was low (68%), and mortality rate was high (35%). CONCLUSIONS: This review confirms that SARS-CoV-2 is associated with a high risk of ALI. Further studies are needed to investigate the association and elucidate potential mechanisms, which may include a hypercoagulable state and hyperactivation of the immune response. Furthermore, management of ALI is not standardized and depends on patient condition and extension of the thrombosed segment. ALI in COVID-19 patients is associated with high risk of failure of revascularization and perioperative mortality.
Authors: Eugenio Martelli; Giovanni Sotgiu; Laura Saderi; Massimo Federici; Giuseppe Sangiorgi; Matilde Zamboni; Allegra R Martelli; Giancarlo Accarino; Giuseppe Bianco; Francesco Bonanno; Umberto M Bracale; Enrico Cappello; Giovanni Cioffi; Giovanni Colacchio; Adolfo Crinisio; Salvatore De Vivo; Carlo Patrizio Dionisi; Loris Flora; Giovanni Impedovo; Francesco Intrieri; Luca Iorio; Gabriele Maritati; Piero Modugno; Mario Monaco; Giuseppe Natalicchio; Vincenzo Palazzo; Fernando Petrosino; Francesco Pompeo; Raffaele Pulli; Davide Razzano; Maurizio R Ruggieri; Carlo Ruotolo; Paolo Sangiuolo; Gennaro Vigliotti; Pietro Volpe; Antonella Biello; Pietro Boggia; Michelangelo Boschetti; Enrico M Centritto; Flavia Condò; Lucia Cucciolillo; Amodio S D'Amodio; Mario De Laurentis; Claudio Desantis; Daniela Di Lella; Giovanni Di Nardo; Angelo Disabato; Ilaria Ficarelli; Angelo Gasparre; Antonio N Giordano; Alessandro Luongo; Mafalda Massara; Vincenzo Molinari; Andrea Padricelli; Marco Panagrosso; Anna Petrone; Serena Pisanello; Roberto Prunella; Michele Tedesco; Alberto M Settembrini Journal: J Pers Med Date: 2022-07-19