ABSTRACT
BACKGROUNDS: Several neurological manifestations, including stroke, have been reported in COVID-19 patients. The putative role of the COVID-19-related hyperinflammatory state in cerebrovascular disorders remains unclear. METHODS: From March 2020 to September 2021, we searched for patients who exhibited an ischemic stroke related to carotid free-floating thrombus (CFFT) to investigate its incidence and relationship with COVID-19. RESULTS: Of 853 ischemic strokes referred to our Stroke Centre during the study period, 5.7% (n = 49) were positive for SARS-CoV-2. Six had CFFT, of which two tested positive for SARS-CoV-2 (2/49 = 4.1%), and four did not (4/802 = 0.5%). The former were two middle-aged men suffering from COVID-19 pneumonia. Floating thrombi were promptly extracted by endarterectomy and endovascular thrombectomy, respectively, with no early and long-term complications. Notably, our COVID-19 patients exhibited little or no atherosclerosis burden on CT angiography, markedly elevated D-dimer levels, and extensive thrombus length. CONCLUSIONS: COVID-19-induced immunothrombosis possibly played a significant pathogenic role in CFFT.
Subject(s)
COVID-19 , Stroke , Thrombosis , Male , Middle Aged , Humans , COVID-19/complications , Thromboinflammation , Cytokine Release Syndrome/complications , SARS-CoV-2 , Stroke/diagnostic imaging , Stroke/etiology , Thrombosis/complications , Thrombosis/diagnostic imagingSubject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/prevention & control , COVID-19 , Vascular Surgical Procedures , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/mortality , Aortic Rupture/etiology , Aortic Rupture/mortality , Clinical Decision-Making , Elective Surgical Procedures , Health Services Needs and Demand , Humans , Needs Assessment , Patient Safety , Risk Assessment , Risk Factors , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/mortalityABSTRACT
OBJECTIVE: This study aimed to evaluate the protocol adopted during the emergency phase of the COVID-19 pandemic to maintain elective activity in a vascular surgery unit while minimising the risk of contamination to both patients and physicians, and the impact of this activity on the intensive care (IC) resources. METHODS: The activity of a vascular surgery unit was analysed from 8 March to 8 April 2020. Surgical activity was maintained only for acute or elective procedures obeying priority criteria. The preventive screening protocol consisted of nasopharyngeal swabs (NPS) for all patients and physicians with symptoms and for unprotected contact infected cases, and serological physician evaluations every 15 days. Patients treated in the acute setting were considered theoretically infected and the necessary protective devices were used. The number of patients and the possible infection of physicians were evaluated. The number and type of interventions and the need for post-operative IC during this period were compared with those in the same periods in 2018 and 2019. RESULTS: One hundred and fifty-one interventions were performed, of which 34 (23%) were acute/emergency. The total number of interventions was similar to those performed in the same periods in 2019 and 2018: 150 (33, of which 22% acute/emergency) and 117 (29, 25% acute/emergency), respectively. IC was necessary after 6% (17% in 2019 and 20% in 2018) of elective operations and 33% (11) of acute/emergency interventions. None of the patients treated electively were diagnosed with COVID-19 infection during hospitalisation. Of the 34 patients treated in acute/emergency interventions, five (15%) were diagnosed with COVID-19 infection. It was necessary to screen 14 (47%) vascular surgeons with NPS after contact with infected colleagues, but none for unprotected contact with patients; all were found to be negative on NPS and serological evaluation. CONCLUSION: A dedicated protocol allowed maintenance of regular elective vascular surgery activity during the emergency phase of the COVID-19 pandemic, with no contamination of patients or physicians and minimal need for IC resources.
Subject(s)
Coronavirus Infections , Elective Surgical Procedures , Emergency Service, Hospital , Infection Control , Pandemics , Pneumonia, Viral , Vascular Diseases , Vascular Surgical Procedures , Adult , Betacoronavirus/isolation & purification , COVID-19 , Clinical Protocols , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Critical Pathways/trends , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Program Evaluation , SARS-CoV-2 , Vascular Diseases/epidemiology , Vascular Diseases/surgery , Vascular Surgical Procedures/methods , Vascular Surgical Procedures/statistics & numerical dataABSTRACT
Acute thromboembolic events appear to be frequent in patients with SARS-CoV-2 infection. We report a case of an intubated patient, who developed a threatening lower limb ischemia. Intra-arterial fibrinolysis and intravenous heparin infusion did not lead to complete recanalization of the tibial arteries, which were successfully treated by surgical embolectomy.