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International Angiology 2022 Aug 01

DOI: 10.23736/S0392-9590.22.04884-2


language: English

The impact of the pandemic for COVID-negative vascular patients: analysis from the Italian epicenter

Efrem CIVILINI 1, 2 , Maria G. PASCUCCI 2, 3, Noemi BARONETTO 2, 3, Andrea MELLONI 4, Virginia VALLESI 4, Andrea KAHLBERG 4, 5, Roberto CHIESA 4, 5, Germano MELISSANO 4, 5

1 Vascular Surgery Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; 2 Humanitas University, Pieve Emanuele, Milan, Italy; 3 Università degli Studi dell’Insubria, Varese, Italy; 4 Università Vita-Salute San Raffaele, Milan, Italy; 5 Vascular Surgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy


BACKGROUND: To face the "first wave" of the pandemic (01/03/2020-15/05/2020), Lombardy’s healthcare system was reorganized according to the "Hub-and-Spoke" model, and deferrable inpatient and outpatient activities were suspended. The limitations imposed by COVID-19, associated with patients' fear of presenting to medical attention, may have led to a delay in diagnosis and treatment of time-dependent pathologies. Our multicenter retrospective cohort study aims at analyzing the impact on COVID-negative patients of the shift of medical resources in Lombardy, the Italian epicenter of the pandemic.
METHODS: Inclusion criteria were an age ≥18, COVID-negative condition, and referral to IRCCS Istituto Clinico Humanitas - Rozzano, Milan (Spoke Center) or IRCCS Ospedale San Raffaele - Milan (Hub Center) for acute vascular diseases requiring urgent treatment. SARS-CoV-2 infection, either on admission or during hospitalization, was the exclusion criterion. Data of the “first wave” were compared with the corresponding months of 2019, to highlight differences in vascular pathologies’ case rates, clinical presentation, treatment type and post-treatment outcomes (mortality, rate of adverse events, primary and secondary clinical success and of amputation).
RESULTS: 202 patients were treated for acute vascular diseases, 52 in 2019, 150 in 2020 (p<.001). A later presentation to medical attention (4.3 versus 5.9 days after symptoms onset, p=.03) and an increased need for urgent treatment for peripheral arterial disease (p=.04) differentiated 2020. A higher number of peripheral arterial disease patients underwent major amputations (p=.38). Access to post-surgical rehabilitation programs was restricted (p<.001).
CONCLUSIONS: During the first wave of COVID-19 pandemic, in the face of a radical health care rearrangement, no increase in mortality nor in post-operative adverse event rate was registered. Anyway, urgent hospitalizations for vascular disease increased, more specifically for peripheral ischemia, in which late presentation may have influenced an increase in amputation rate.

KEY WORDS: COVID-19; Vascular surgery; Emergencies; Aneurysms; Carotid artery disease; Peripheral arterial disease; Ischemia; Amputation; Hub&Spoke; Pandemics

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