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Vasc Endovascular Surg ; 55(5): 429-433, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1021329


BACKGROUND: In many facilities, the coronavirus disease (COVID-19) pandemic caused suspension of elective surgery. We therefore sought to determine the impact of this on the surgical experience of vascular trainees. METHODS: Surgical case volume, breadth, and the participating trainee post-graduate level from 3 large New York City Hospitals with integrated residency and fellowship programs (Mount Sinai, Montefiore Medical Center/Albert Einstein College of Medicine, and New York University) were reviewed. Procedures performed between February 26 to March 25, 2020 (pre-pandemic month) and March 26 to April 25, 2020 (peak pandemic period) were compared to those performed during the same time period in 2019. The trainees from these programs were also sent surveys to evaluate their subjective experience during this time. RESULTS: The total number of cases during the month leading into the peak pandemic period was 635 cases in 2019 and 560 cases in 2020 (12% decrease). During the peak pandemic period, case volume decreased from 445 in 2019 to 114 in 2020 (74% reduction). The highest volume procedures during the peak pandemic month in 2020 were amputations and peripheral cases for acute limb ischemia; during the 2019 period, the most common cases were therapeutic endovascular procedures. There was a decrease in case volume for vascular senior residents of 77% and vascular junior and midlevel residents of 75%. There was a 77% survey response rate with 50% of respondents in the senior years of training. Overall, 20% of respondents expressed concern about completing ACGME requirements due to the COVID-19 pandemic. CONCLUSIONS: Vascular surgery-specific clinical educational and operative experiences during redeployment efforts have been limited. Further efforts should be directed to quantify the impact on training and to evaluate the efficacy of training supplements such as teleconferences and simulation.

COVID-19/prevention & control , Clinical Competence , General Surgery/education , Internship and Residency/organization & administration , Vascular Surgical Procedures/education , Workload , COVID-19/epidemiology , COVID-19/transmission , Communicable Disease Control , Curriculum , Humans , New York
J Vasc Surg ; 73(3): 789-796, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-863656


BACKGROUND: Coronavirus disease 2019 (COVID-19) is a novel coronavirus that has typically resulted in upper respiratory symptoms. However, we have encountered acute arterial and venous thrombotic events after COVID-19 infection. Managing acute thrombotic events from the novel virus has presented unprecedented challenges during the COVID-19 pandemic. In our study, we have highlighted the unique treatment required for these patients and discussed the role of anticoagulation for patients diagnosed with COVID-19. METHODS: The data from 21 patients with laboratory-confirmed COVID-19 disease and acute venous or arterial thrombosis were collected. The demographics, comorbidities, home medications, laboratory markers, and outcomes were analyzed. The primary postoperative outcome of interest was mortality, and the secondary outcomes were primary patency and morbidity. To assess for significance, a univariate analysis was performed using the Pearson χ2 and Fisher exact tests for categorical variables and the Student t test for continuous variables. RESULTS: A total of 21 patients with acute thrombotic events met our inclusion and exclusion criteria. Most cases were acute arterial events (76.2%), with the remainder venous cases (23.8%). The average age for all patients was 64.6 years, and 52.4% were male. The most prevalent comorbidity in the group was hypertension (81.0%). Several markers were markedly abnormal in both arterial and venous cases, including an elevated neutrophil/lymphocyte ratio (8.8) and D-dimer level (4.9 µg/mL). Operative intervention included percutaneous angiography in 25.00% of patients and open surgical embolectomy in 23.8%. Most of the patients who had undergone arterial intervention had developed a postoperative complication (53.9%) compared with a 0% complication rate after venous interventions. Acute kidney injury on admission was a factor in 75.0% of those who died vs 18.2% in the survivors (P = .04). CONCLUSIONS: We have described our experience in the epicenter of the pandemic of 21 patients who had experienced major thrombotic events from infection with COVID-19. The findings from our cohort have highlighted the need for increased awareness of the vascular manifestations of COVID-19 and the important role of anticoagulation for these patients. More data are urgently needed to optimize treatment and prevent further vascular complications of COVID-19 infections.

Blood Coagulation Disorders/therapy , Blood Coagulation Disorders/virology , COVID-19/complications , Acute Disease , Aged , Blood Coagulation Disorders/epidemiology , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , New York City/epidemiology , Pandemics , Retrospective Studies , Risk Factors , SARS-CoV-2
J Vasc Surg Cases Innov Tech ; 6(3): 381-383, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-599228


We describe three patients with COVID-19 who presented with an acute vascular event rather than with typical respiratory symptoms. These patients were all subsequently found to have laboratory-confirmed COVID-19 infections as the likely cause of their thrombotic event. The primary presentation of COVID-19 infection as a thrombotic event rather than with respiratory symptoms has not been described elsewhere. Our cases and discussion highlight the thrombotic complications caused by COVID-19; we discuss management of these patients and explore the role of anticoagulation in patients diagnosed with COVID-19.