Home > Journals > The Journal of Cardiovascular Surgery > Past Issues > Articles online first > The Journal of Cardiovascular Surgery 2021 Sep 28

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe PROMO
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as
Share

 

 

The Journal of Cardiovascular Surgery 2021 Sep 28

DOI: 10.23736/S0021-9509.21.12017-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

COVID-19 and acute limb ischemia: a systematic review

Luca ATTISANI 1 , Alessandro PUCCI 1, Giorgio LUONI 1, Luca LUZZANI 1, Matteo A. PEGORER 1, Alberto M. SETTEMBRINI 2, Daniele BISSACCO 2, Max V. WOHLAUER 3, Gabriele PIFFARETTI 4, Raffaello BELLOSTA 1

1 Vascular and Endovascular Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy; 2 Vascular Surgery Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy; 3 Vascular Surgery, University of Colorado, Denver, CO, USA; 4 Vascular Surgery, ASST Sette Laghi, Varese, Italy


PDF


INTRODUCTION: The main goal of this systematic review is to analyze the outcomes of acute limb ischemia (ALI) in patients suffering from the novel Coronavirus COVID-19 (Sars-Cov-2).
EVIDENCE OF 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. The majority of 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’s condition and extension of the thrombosed segment. ALI in COVID-19 patients is associated with high risk of failure of revascularization and perioperative mortality.


KEY WORDS: COVID-19; Acute limb ischemia; Vascular surgery; Peripheral artery disease; SARSCoV-2

top of page