Skip to main content
2022 Vascular Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Mobile app: click "Join" in the footer.
Mobile app: click "Join" in the footer.
Registration Required
Registration Required

VESS Paper Session

VESS02 - Revascularization Outcomes of Acute Limb Ischemia in Patients with COVID-19

Wednesday, June 15, 2022
1:03 PM - 1:14 PM EDT
Objectives: Acute limb ischemia (ALI) is one of the most catastrophic thrombotic manifestations of COVID-19 resulting in limb loss if not promptly treated. Our goal is to evaluate revascularization outcomes of ALI in patients with COVID-19 who underwent either open or endovascular treatment.

Methods: The Vascular Surgery COVID-19 Collaborative (VASCC) started in March 2020 to assess hematological changes of COVID-19. We performed an interim data analysis on 46 patients with COVID-19 associated ALI submitted to the ALI module of the VASCC REDcap database from 10 institutions in the United States.

Results: Among the 46 patients included in the analysis, the mean age was 62.2 years (SD 9.51). The majority of patients were male (73.9%). A total of 67.4% were White, 13% were Hispanic, and 4.3% were Black. 93.5% of patients met Rutherford’s criteria of ALI classes 2 or 3. On average, patients developed ALI 12.2 (SD 13.5) days after a positive COVID test. Revascularization was attempted using open thrombectomy in 50.0%, endovascular lysis or thrombectomy in 23.9%, bypass in 2.2%, and revascularization wasn’t attempted in 23.9% of the patients (Table I). Revascularization was successful in 41.3% with symptom resolution, 15.2% with limb salvage but persistent symptoms, 2.2% had minor amputation, 4.3% ultimately had a major amputation, 4.3% required reoperation, and revascularization was unsuccessful in 10.9% of patients. The average length of hospital stay was 13.2 (SD 13.3) days, the average ICU length of stay was 4.66 (SD 6.85) days, and the average ventilation days was 12.3 (SD 10.8) days. Overall, in-hospital mortality was 21.7%, 8.7% had major amputation, 8.7% had stroke, 6.5% required major limb intervention, and 2.2% had sepsis.

Successful revascularization rate was 62.5% in the 24 patients who underwent open surgery versus 36.4% in the 11 patients who underwent endovascular repair. The average length of stay in the ICU was shorter in the open group (mean= 3.24 days) than in the endovascular group (mean= 8.60 days). Of the 11 patients who had no revascularization attempt, 36.4% died, 18.2% had a major amputation, 9.1% had a pulmonary embolism, and 9.1% had a stroke.

Conclusions: COVID-19 associated ALI carries a high mortality. Patients with COVID-19 who develop ALI can be managed successfully with open surgery or endovascular intervention. In our cohort, open revascularization resulted in reduced ICU stay and reduced ventilation days with improved limb salvage than the endovascular group. Further data are needed to develop management algorithms for ALI in patients with COVID-19.