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J Vasc Surg ; 72(3): 790-798, 2020 09.
Article in English | MEDLINE | ID: covidwho-701461


The global SARS-CoV-2/COVID-19 pandemic has required a reduction in nonemergency treatment for a variety of disorders. This report summarizes conclusions of an international multidisciplinary consensus group assembled to address evaluation and treatment of patients with thoracic outlet syndrome (TOS), a group of conditions characterized by extrinsic compression of the neurovascular structures serving the upper extremity. The following recommendations were developed in relation to the three defined types of TOS (neurogenic, venous, and arterial) and three phases of pandemic response (preparatory, urgent with limited resources, and emergency with complete diversion of resources). • In-person evaluation and treatment for neurogenic TOS (interventional or surgical) are generally postponed during all pandemic phases, with telephone/telemedicine visits and at-home physical therapy exercises recommended when feasible. • Venous TOS presenting with acute upper extremity deep venous thrombosis (Paget-Schroetter syndrome) is managed primarily with anticoagulation, with percutaneous interventions for venous TOS (thrombolysis) considered in early phases (I and II) and surgical treatment delayed until pandemic conditions resolve. Catheter-based interventions may also be considered for selected patients with central subclavian vein obstruction and threatened hemodialysis access in all pandemic phases, with definitive surgical treatment postponed. • Evaluation and surgical treatment for arterial TOS should be reserved for limb-threatening situations, such as acute upper extremity ischemia or acute digital embolization, in all phases of pandemic response. In late pandemic phases, surgery should be restricted to thrombolysis or brachial artery thromboembolectomy, with more definitive treatment delayed until pandemic conditions resolve.

Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Thoracic Outlet Syndrome/diagnosis , Triage/standards , COVID-19 , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Decompression, Surgical/standards , Elective Surgical Procedures/methods , Elective Surgical Procedures/standards , Emergency Treatment/methods , Emergency Treatment/standards , Humans , Infection Control/standards , Interdisciplinary Communication , Limb Salvage/methods , Limb Salvage/standards , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , SARS-CoV-2 , Telemedicine/standards , Thoracic Outlet Syndrome/etiology , Thoracic Outlet Syndrome/therapy , Thrombolytic Therapy/methods , Thrombolytic Therapy/standards , Time-to-Treatment/standards
J Vasc Surg ; 73(2): 392-398, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-628496


Implementation of telemedicine for patient encounters optimizes personal safety and allows for continuity of patient care. Embracing telehealth reduces the use of personal protective equipment and other resources consumed during in-person visits. The use of telehealth has increased to historic levels in response to the coronavirus disease 2019 (COVID-19) pandemic. Telehealth may be a key modality to fight against COVID-19, allowing us to take care of patients, conserve personal protective equipment, and protect health care workers all while minimizing the risk of viral spread. We must not neglect vascular health issues while the coronavirus pandemic continues to flood many hospitals and keep people confined to their homes. Patients are not immune to diseases and illnesses such as stroke, critical limb ischemia, and deep vein thrombosis while being confined to their homes and afraid to visit hospitals. Emerging from the COVID-19 crisis, incorporating telemedicine into routine medical care is transformative. By leveraging digital technology, the authors discuss their experience with the implementation, workflow, coding, and reimbursement issues of telehealth during the COVID-19 era.

COVID-19 , Pandemics , Patient Care , Telemedicine , Vascular Diseases , Clinical Coding , Humans , Insurance, Health, Reimbursement/economics , Insurance, Health, Reimbursement/standards , Licensure, Medical , Mobile Applications , Patient Care/economics , Patient Care/methods , Patient Care/standards , Patient Selection , SARS-CoV-2 , Telemedicine/economics , Telemedicine/organization & administration , Telemedicine/standards , Telemedicine/trends , United States , United States Department of Veterans Affairs , Vascular Diseases/diagnosis , Vascular Diseases/economics , Vascular Diseases/therapy , Workflow