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1.
Eur J Phys Rehabil Med ; 58(3): 452-461, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1687746

ABSTRACT

INTRODUCTION: Advanced technologies have made available the development of microprocessor prosthetic knee (MPK) to improve autonomy of patients with lower limb amputation. In the present systematic review, we aimed to evaluate the impact of the use of all types of MPK on patients' functional status and quality of life. EVIDENCE ACQUISITION: We conducted this review according to the PRISMA Guidelines on Medline (via Ovid), Scopus and SportDiscuss. All identified articles were screened for their eligibility by two reviewers using Covidence software. The Cochrane Risk of Bias (RoB) or the NIH Quality Assessment Tool were used to assess the quality of the studies. EVIDENCE SYNTHESIS: Eighteen articles were included in the present review (7 randomized controlled trials - RCT), 6 cross-sectional and 5 follow-up studies). Number of participants included varied from 20 to 602, protocols' length varied from a single session to 12 weeks of use of MPK. Taken together, MPK users compared to NMPK users tend to present better functional status and mobility. Quality of life was also positively impacted in MPK users. On the other hand, the superiority of more advanced MPKs such as the Genium® is less clear, especially given the improvements over time of other MPKs such as the C-leg® and the Rheo knee®. CONCLUSIONS: Based on our results, while it is clear that MPKs outperform NMPKs both for functional status and quality of life, additional benefits of one MPK over another is less clear. Future studies are needed to clarify these aspects.


Subject(s)
Amputees , Knee Prosthesis , Amputation , Cross-Sectional Studies , Humans , Lower Extremity/surgery , Microcomputers , Prosthesis Design , Quality of Life
2.
Int J Low Extrem Wounds ; 21(2): 197-200, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1582582

ABSTRACT

An 84-year-old male patient with no known comorbidity was admitted to the emergency department with complaints of dyspnea and respiratory distress. The patient was referred to the COVID outpatient clinic, laboratory and radiology tests were performed. Thoracic CT scan of the patient showed large peripheral patchy ground glass densities observed in the lower lobes of both lungs. CT imaging findings were evaluated by an experienced radiologist and reported as COVID-19 pneumonia. The patient, who was self-isolated at home for 5 days, presented to the emergency department again on the fifth day with complaints of respiratory distress, fever, bruising with cough, and loss of peripheral pulse in the left lower extremity. Necessary tests were performed on the patient. An above-knee amputation was performed when a diagnosis of limb ischemic necrosis was made and no revascularization attempt was considered by the CVS department. This case study describes the coexistence of sudden lower extremity thrombosis and Covid-19 in our case without a known chronic disease.


Subject(s)
COVID-19 , Peripheral Arterial Disease , Peripheral Vascular Diseases , Respiratory Distress Syndrome , Aged, 80 and over , Amputation , COVID-19/complications , Humans , Ischemia/etiology , Ischemia/surgery , Limb Salvage , Lower Extremity/surgery , Male , Peripheral Arterial Disease/diagnosis , Retrospective Studies , Risk Factors , Treatment Outcome
3.
BMC Cardiovasc Disord ; 21(1): 592, 2021 12 09.
Article in English | MEDLINE | ID: covidwho-1566507

ABSTRACT

BACKGROUND: COVID-19 and Fontan physiology have each been associated with an elevated risk of venous thromboembolism (VTE), however little is known about the risks and potential consequences of having both. CASE PRESENTATION: A 51 year old male with tricuspid atresia status post Fontan and extracardiac Glenn shunt, atrial flutter, and sinus sick syndrome presented with phlegmasia cerulea dolens (PCD) of the left lower extremity in spite of supratherapeutic INR in the context of symptomatic COVID-10 pneumonia. He was treated with single session, catheter directed mechanical thrombectomy that was well-tolerated. CONCLUSIONS: This report of acute PCD despite therapeutic anticoagulation with a Vitamin K antagonist, managed with emergent mechanical thrombectomy, calls to attention the importance of altered flow dynamics in COVID positive patients with Fontan circulation that may compound these independent risk factors for developing deep venous thrombosis with the potential for even higher morbidity.


Subject(s)
COVID-19 , Fontan Procedure , Gangrene , Mechanical Thrombolysis , Postoperative Complications , Thrombophlebitis , Tricuspid Atresia , Warfarin/therapeutic use , Amputation/methods , Atrial Flutter/drug therapy , Atrial Flutter/etiology , COVID-19/blood , COVID-19/complications , COVID-19/therapy , Fontan Procedure/adverse effects , Fontan Procedure/methods , Gangrene/etiology , Gangrene/surgery , Heart Defects, Congenital/surgery , Humans , Image Processing, Computer-Assisted/methods , Lower Extremity/blood supply , Lower Extremity/pathology , Lower Extremity/surgery , Male , Mechanical Thrombolysis/adverse effects , Mechanical Thrombolysis/methods , Middle Aged , Phlebography/methods , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/etiology , Thrombophlebitis/diagnosis , Thrombophlebitis/etiology , Thrombophlebitis/surgery , Tomography, X-Ray Computed/methods , Treatment Outcome , Tricuspid Atresia/etiology , Tricuspid Atresia/surgery
4.
Ann R Coll Surg Engl ; 103(9): 694-700, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1480440

ABSTRACT

INTRODUCTION: The Vascular Society of Great Britain and Ireland (VSGBI) Peripheral Arterial Disease Quality Improvement Framework (PAD QIF) stipulates targets for managing patients with chronic limb-threatening ischaemia (CLTI); however, it is unknown whether these are achievable. This survey aims to evaluate contemporary practice for managing CLTI in the UK. METHODS: A questionnaire was developed in conjunction with the VSGBI to survey the management of CLTI and canvass opinions on the PAD QIF. The survey was distributed to all consultant members of the VSGBI and through a targeted social media campaign. RESULTS: Forty-seven consultant vascular surgeons based at 36 arterial centres across the UK responded (response rate from arterial centres = 46%). Only 14.3% of centres provided outpatient consultation within the target of seven days from referral, with only one centre providing revascularisation within the target of seven days from consultation. For inpatient management, 31.6% provided surgical and 23.8% endovascular revascularisation within the target of three days from assessment. While 60% of participants believe the PAD QIF's 5-day 'admitted care' pathway is achievable, only 28.6% thought the 14-day 'non-admitted care' pathway was feasible. Challenges to meeting these targets include the availability of theatre space and angiography lists, and availability of outpatient appointments for patient assessment. CONCLUSIONS: The opinion of UK vascular surgeons indicates that achieving the targets of the PAD QIF represents a major challenge based upon current services. Adapting existing services with a greater focus on providing an 'urgent' model of care may help to potentially overcome these challenges.


Subject(s)
Ischemia/surgery , Lower Extremity/blood supply , Lower Extremity/surgery , Peripheral Arterial Disease/surgery , Practice Patterns, Physicians' , Specialties, Surgical , Vascular Surgical Procedures , Chronic Disease , Health Care Surveys , Humans , Limb Salvage , United Kingdom
5.
Ann Vasc Surg ; 72: 209-215, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1385038

ABSTRACT

BACKGROUND: Both arterial and venous thrombotic events of the extremities occur in coronavirus disease 2019 (COVID-19) infection, but the etiology of these events remains unclear. This study sought to evaluate pathology specimens of COVID-19-positive patients postamputation, who were found to have Rutherford 3 acute limb ischemia requiring amputation. METHODS: A retrospective review was performed of all vascular surgery emergency room and inpatient consultations in patients who presented to the Mount Sinai Health System from March 26, 2020, to May 10, 2020. Pathology specimens were examined using hematoxylin and eosin stain. The specimens were assessed for the following: inflammatory cells associated with endothelium/apoptotic bodies, mononuclear cells, small vessel congestion, and lymphocytic endotheliitis. Of the specimens evaluated, 2 patients with a known history of peripheral vascular disease were excluded. RESULTS: Inflammatory cells associated with endothelium/apoptotic bodies were seen in all 4 patients and in 4 of 5 specimens. Mononuclear cells were found in 2 of 4 patients. Small vessel congestion was seen in all patients. Lymphocytic endotheliitis was seen in 1 of 4 patients. CONCLUSIONS: This study shows endotheliitis in amputation specimens of four patients with COVID-19 disease and Rutherford Class 3 acute limb ischemia. The findings in these patients is more likely an infectious angiitis because of COVID-19.


Subject(s)
Amputation , COVID-19/complications , Endothelium, Vascular/virology , Lower Extremity/blood supply , Lower Extremity/surgery , Thrombosis/surgery , Thrombosis/virology , Acute Disease , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
7.
Diabet Med ; 38(7): e14577, 2021 07.
Article in English | MEDLINE | ID: covidwho-1165904

ABSTRACT

AIMS/HYPOTHESIS: The aim of this study was to examine the impact of the COVID-19 epidemic on the hospitalization rates for diabetic foot ulcer (DFU), osteomyelitis and lower limb revascularization procedure in people with DFU. METHODS: This nationwide retrospective cohort study included hospital data on all people hospitalized in France for diabetes in weeks 2-43 in 2020, including the COVID-19 lockdown period, compared to same period in 2019. RESULTS: The number of hospitalizations for DFU decreased significantly in weeks 12-19 (during the lockdown) (p < 10-4 ). Hospitalization for foot osteomyelitis also decreased significantly in weeks 12-19 (p < 10-4 ). The trend was the same for lower limb amputations and revascularizations associated with DFU or amputation. CONCLUSIONS/INTERPRETATION: The marked drop in hospitalization rates for DFU, osteomyelitis and lower limb revascularization procedures in people with DFU observed in France during the lockdown period suggests that COVID-19 was a barrier to DFU care, and may illustrate the combined deleterious effects of hospital overload and changes in health-related behaviour.


Subject(s)
COVID-19/epidemiology , Diabetic Foot/epidemiology , Diabetic Foot/therapy , Hospitalization/statistics & numerical data , Quarantine , Aged , Aged, 80 and over , Amputation/statistics & numerical data , Amputation/trends , COVID-19/prevention & control , Cohort Studies , Communicable Disease Control/methods , Epidemics , Female , France/epidemiology , History, 21st Century , Hospitalization/trends , Humans , Lower Extremity/surgery , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/physiology
8.
Ann Vasc Surg ; 72: 209-215, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1056323

ABSTRACT

BACKGROUND: Both arterial and venous thrombotic events of the extremities occur in coronavirus disease 2019 (COVID-19) infection, but the etiology of these events remains unclear. This study sought to evaluate pathology specimens of COVID-19-positive patients postamputation, who were found to have Rutherford 3 acute limb ischemia requiring amputation. METHODS: A retrospective review was performed of all vascular surgery emergency room and inpatient consultations in patients who presented to the Mount Sinai Health System from March 26, 2020, to May 10, 2020. Pathology specimens were examined using hematoxylin and eosin stain. The specimens were assessed for the following: inflammatory cells associated with endothelium/apoptotic bodies, mononuclear cells, small vessel congestion, and lymphocytic endotheliitis. Of the specimens evaluated, 2 patients with a known history of peripheral vascular disease were excluded. RESULTS: Inflammatory cells associated with endothelium/apoptotic bodies were seen in all 4 patients and in 4 of 5 specimens. Mononuclear cells were found in 2 of 4 patients. Small vessel congestion was seen in all patients. Lymphocytic endotheliitis was seen in 1 of 4 patients. CONCLUSIONS: This study shows endotheliitis in amputation specimens of four patients with COVID-19 disease and Rutherford Class 3 acute limb ischemia. The findings in these patients is more likely an infectious angiitis because of COVID-19.


Subject(s)
Amputation , COVID-19/complications , Endothelium, Vascular/virology , Lower Extremity/blood supply , Lower Extremity/surgery , Thrombosis/surgery , Thrombosis/virology , Acute Disease , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
9.
Clin Imaging ; 75: 1-4, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1039316

ABSTRACT

We describe a 40-year-old man with severe COVID-19 requiring mechanical ventilation who developed aorto-bi-iliac arterial, right lower extremity arterial, intracardiac, pulmonary arterial and ilio-caval venous thromboses and required right lower extremity amputation for acute limb ischemia. This unique case illustrates COVID-19-associated thrombotic complications occurring at multiple, different sites in the cardiovascular system of a single infected patient.


Subject(s)
COVID-19 , Hypertension, Pulmonary , Thrombosis , Venous Thrombosis , Adult , Amputation , Humans , Leg/diagnostic imaging , Leg/surgery , Lower Extremity/diagnostic imaging , Lower Extremity/surgery , Male , SARS-CoV-2 , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/surgery , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/surgery
10.
J Atheroscler Thromb ; 28(1): 90-95, 2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-736814

ABSTRACT

Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute infectious disease that spreads mainly via the respiratory route. Elderly patients or those with underlying diseases are more seriously affected. We report a case of COVID-19 infection in a geriatric patient with arteriovenous thrombosis of the right lower limb. Despite persistent anticoagulant therapy, the patient's arterial thrombosis continued to progress and presented with ischemic necrosis of the lower extremity. After amputation in this case, the levels of D-dimer and inflammatory cytokine increased progressively, and he presented with acute myocardial infarction, which progressed rapidly to multisystem organ failure. However, whether coronavirus can directly cause the damage of the cardiovascular system and thrombosis needs further investigation.


Subject(s)
Amputation , COVID-19 , Lower Extremity , Multiple Organ Failure , Myocardial Infarction , Postoperative Complications , SARS-CoV-2/isolation & purification , Thrombosis , Aged , Amputation/adverse effects , Amputation/methods , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , Fatal Outcome , Femoral Artery/diagnostic imaging , Femoral Vein/diagnostic imaging , Humans , Lower Extremity/blood supply , Lower Extremity/pathology , Lower Extremity/surgery , Male , Multiple Organ Failure/diagnosis , Multiple Organ Failure/etiology , Multiple Organ Failure/therapy , Myocardial Infarction/diagnosis , Myocardial Infarction/etiology , Myocardial Infarction/therapy , Necrosis/etiology , Necrosis/surgery , Postoperative Complications/blood , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Thrombosis/complications , Thrombosis/etiology , Thrombosis/physiopathology , Thrombosis/therapy , Ultrasonography/methods
11.
J Rehabil Med ; 52(9): jrm00094, 2020 Sep 02.
Article in English | MEDLINE | ID: covidwho-688737

ABSTRACT

OBJECTIVE: To evaluate the clinical characteristics and rehabilitation management of patients who undergo amputation for COVID-19-associated coagulopathy. METHODS: Clinical and laboratory data for 3 patients were analysed and their rehabilitative management discussed. RESULTS: The medical records of 3 patients who had undergone amputation due to acute lower extremity ischaemia and who were provided with rehabilitation in our COVID-19 unit were reviewed. CONCLUSION: Coagulation changes related to SARS-CoV-2 may complicate recovery from this devastating disease. The rehabilitation management of amputated patients for COVID-19 acute lower extremity ischaemia is based on a multilevel approach for clinical, functional, nutritional and neuropsychological needs. Based on this limited experience, a dedicated programme for this specific group of patients seems advantageous to warrant the best functional outcome and quality of life.


Subject(s)
Amputation/rehabilitation , Betacoronavirus , Blood Coagulation Disorders/virology , Coronavirus Infections/complications , Coronavirus Infections/rehabilitation , Ischemia/virology , Lower Extremity/blood supply , Pneumonia, Viral/complications , Pneumonia, Viral/rehabilitation , Aged , Blood Coagulation Disorders/rehabilitation , Blood Coagulation Disorders/surgery , COVID-19 , Humans , Ischemia/rehabilitation , Ischemia/surgery , Italy , Lower Extremity/surgery , Male , Middle Aged , Pandemics , Quality of Life , SARS-CoV-2
12.
Mil Med ; 185(11-12): e2124-e2130, 2020 12 30.
Article in English | MEDLINE | ID: covidwho-619118

ABSTRACT

INTRODUCTION: In response to the Coronavirus 2019 (COVID-19) pandemic, vascular surgeons in the Veteran Affairs Health Care System have been undertaking only essential cases, such as advanced critical limb ischemia. Surgical risk assessment in these patients is often complex, considers all factors known to impact short- and long-term outcomes, and the additional risk that COVID-19 infection could convey in this patient population is unknown. The European Centre for Disease Prevention and Control (ECDC) published risk factors (ECDC-RF) implicated in increased COVID-19 hospitalization and case-fatality which have been further evidenced by initial reports from the United States Centers for Disease Control and Prevention. CDC reports additionally indicate that African American (AA) patients have incurred disparate infection outcomes in the United States. We set forth to survey the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database over a nearly 20 year span to inform ongoing risk assessment with an estimation of the prevalence of ECDC-RF in our veteran critical limb ischemia population and investigate whether an increased COVID-19 comorbidity burden exists for AA veterans presenting for major non-traumatic amputation. MATERIALS AND METHODS: The VASQIP database was queried for all above knee amputation (AKA) and below knee amputation (BKA) completed 1999-2018 after IRB approval (MIRB:#02507). Patient race and ECDC-RF including male gender, age > 60 years, smoking status, hypertension, diabetes, chronic obstructive pulmonary disease, cancer, and cardiovascular disease were recorded from preoperative patient history. AKA and BKA cohorts were compared via χ2-test with Yates correction or unpaired t-test and a subgroup analysis was conducted between AA and all other race patients for COVID-19 comorbidities in each cohort. RESULTS: VASQIP query returned 50,083 total entries. Average age was 65.1 ± 10.4 years and 68.2 ± 10.5 years for BKA and AKA cohorts, respectively, (P < .0001) and nearly all patients were male (99%). At least one ECDC-RF comorbidity was present in 25,526 (88.7%) of BKA and 17,558 (82.4%) of AKA patients (P < .0001). AA BKA patients were significantly more likely than non-AA BKA patients to present with at least one ECDC-RF comorbidity (P = .01). CONCLUSIONS: According to a large national Veterans Affairs database, there are high rates of ECDC-RF in veteran amputees. During the present crisis, management of these patients should incorporate telehealth, expedient discharge, and ongoing COVID-19 transmission precautions.


Subject(s)
Amputation/statistics & numerical data , Lower Extremity/surgery , Pandemics/prevention & control , Veterans/statistics & numerical data , Aged , Aged, 80 and over , Amputation/methods , Amputees/statistics & numerical data , COVID-19/complications , COVID-19/prevention & control , Female , Humans , Lower Extremity/injuries , Male , Middle Aged , Pandemics/statistics & numerical data , Prevalence , Retrospective Studies , Risk Factors , Treatment Outcome , United States , United States Department of Veterans Affairs/organization & administration , United States Department of Veterans Affairs/statistics & numerical data
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