Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 25
Filter
2.
J Cardiovasc Surg (Torino) ; 62(6): 558-570, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1625283

ABSTRACT

BACKGROUND: The COVIDSurg collaborative was an international multicenter prospective analysis of perioperative data from 235 hospitals in 24 countries. It found that perioperative COVID-19 infection was associated with a mortality rate of 24%. At the same time, the COVER study demonstrated similarly high perioperative mortality rates in vascular surgical patients undergoing vascular interventions even without COVID-19, likely associated with the high burden of comorbidity associated with vascular patients. This is a vascular subgroup analysis of the COVIDSurg cohort. METHODS: All patients with a suspected or confirmed diagnosis of COVID-19 in the 7 days prior to, or in the 30 days following a vascular procedure were included. The primary outcome was 30-day mortality. Secondary outcomes were pulmonary complications (adult respiratory distress syndrome, pulmonary embolism, pneumonia and respiratory failure). Logistic regression was undertaken for dichotomous outcomes. RESULTS: Overall, 602 patients were included in this subgroup analysis, of which 88.4% were emergencies. The most common operations performed were for vascular-related dialysis access procedures (20.1%, N.=121). The combined 30-day mortality rate was 27.2%. Composite secondary pulmonary outcomes occurred in half of the vascular patients (N.=275, 45.7%). CONCLUSIONS: Mortality following vascular surgery in COVID positive patients was significantly higher than levels reported pre-pandemic, and similar to that seen in other specialties in the COVIDSurg cohort. Initiatives and surgical pathways that ensure vascular patients are protected from exposure to COVID-19 in the peri-operative period are vital to protect against excess mortality.


Subject(s)
COVID-19/therapy , Global Health/trends , Outcome and Process Assessment, Health Care/trends , Vascular Diseases/surgery , Vascular Surgical Procedures/trends , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Patient Safety , Prospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Vascular Diseases/diagnosis , Vascular Diseases/mortality , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/mortality , Young Adult
4.
Int J Biol Macromol ; 193(Pt A): 948-955, 2021 Dec 15.
Article in English | MEDLINE | ID: covidwho-1471998

ABSTRACT

The severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) keeps on destroying normal social integrity worldwide, bringing about extraordinary medical services, cultural and financial interruption. Individuals with diabetes have been demonstrated to be at higher risk of complications and even death when exposed to SARS-CoV-2. Regardless of pandemic scale infection, there is presently limited comprehension on the potential impact of SARS-CoV-2 on individuals with diabetes. Human serum albumin (HSA) is the most abundant circulating plasma protein in human serum and attracted more interest from researchers because most susceptible to non-enzymatic glycation reactions. Albumin down-regulates the expression of ACE2 that is the target receptor of COVID-19. Hypoalbuminemia, coagulopathy, and vascular disease have been connected in COVID-19 and appear to predict outcomes independent of age and morbidity. This review discusses the most recent evidence that the ACE/ACE2 ratio could influence by human serum albumin both the susceptibility of individuals to SARS-CoV-2 infection and the outcome of the COVID-19 disease.


Subject(s)
Angiotensin-Converting Enzyme 2/blood , COVID-19 , SARS-CoV-2/metabolism , Serum Albumin, Human/metabolism , Blood Coagulation Disorders/blood , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/therapy , COVID-19/blood , COVID-19/diagnosis , COVID-19/therapy , Disease Susceptibility , Humans , Vascular Diseases/blood , Vascular Diseases/diagnosis , Vascular Diseases/therapy
7.
Semin Vasc Surg ; 34(2): 13-19, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1240795

ABSTRACT

This is a retrospective review of a pilot program to provide in home vascular testing to patients during the COVID-19 Pandemic. Results: Eighty-four patients underwent a total of 105 vascular imaging tests as part of the program. Two patients required hospitalization secondary to imaging findings. A description of the program, the results of the testing and patient experience with in-home vascular testing is discussed.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control , Home Care Services , Point-of-Care Testing , Ultrasonography , Vascular Diseases/diagnosis , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/transmission , Feasibility Studies , Female , Humans , Male , Middle Aged , Pilot Projects , Retrospective Studies
10.
Vascular ; 29(6): 856-864, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1052392

ABSTRACT

BACKGROUND/OBJECTIVE: The unprecedented pandemic spread of the novel coronavirus has severely impacted the delivery of healthcare services in the United States and around the world, and has exposed a variety of inefficiencies in healthcare infrastructure. Some states have been disproportionately affected such as New York and Michigan. In fact, Detroit and its surrounding areas have been named as the initial Midwest epicenter where over 106,000 cases have been confirmed in April 2020. METHOD, RESULTS AND CONCLUSIONS: Facilities in Southeast Michigan have served as the frontline of the pandemic in the Midwest and in order to cope with the surge, rapid, and in some cases, complete restructuring of care was mandatory to effect change and attempt to deal with the emerging crisis. We describe the initial experience and response of 4 large vascular surgery health systems in Michigan to COVID-19.


Subject(s)
COVID-19 , Health Care Rationing , Hospital Restructuring , Infection Control , Resource Allocation , Vascular Diseases , Vascular Surgical Procedures , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/therapy , Civil Defense/standards , Hospital Restructuring/methods , Hospital Restructuring/organization & administration , Humans , Infection Control/methods , Infection Control/organization & administration , Michigan/epidemiology , Organizational Innovation , Patient Selection , SARS-CoV-2 , Telemedicine/organization & administration , Vascular Diseases/diagnosis , Vascular Diseases/epidemiology , Vascular Diseases/surgery , Vascular Surgical Procedures/organization & administration , Vascular Surgical Procedures/statistics & numerical data
11.
Eur J Vasc Endovasc Surg ; 61(2): 306-315, 2021 02.
Article in English | MEDLINE | ID: covidwho-921971

ABSTRACT

OBJECTIVE: During the most aggressive phase of the COVID-19 outbreak in Italy, the Regional Authority of Lombardy identified a number of hospitals, named Hubs, chosen to serve the whole region for highly specialised cases, including vascular surgery. This study reports the experience of the four Hubs for Vascular Surgery in Lombardy and provides a comparison of in hospital mortality and major adverse events (MAEs) according to COVID-19 testing. METHODS: Data from all patients who were referred to the Vascular Surgery Department of Hubs from 9 March to 28 April 2020 were collected prospectively and analysed. A positive COVID-19 polymerase chain reaction swab test, or symptoms (fever > 37.5 °C, upper respiratory tract symptoms, chest pain, and contact/travel history) associated with interstitial pneumonia on chest computed tomography scan were considered diagnostic of COVID-19 disease. Patient characteristics, operative variables, and in hospital outcomes were compared according to COVID-19 testing. A multivariable model was used to identify independent predictors of in hospital death and MAEs. RESULTS: Among 305 included patients, 64 (21%) tested positive for COVID-19 (COVID group) and 241 (79%) did not (non-COVID group). COVID patients presented more frequently with acute limb ischaemia than non-COVID patients (64% vs. 23%; p < .001) and had a significantly higher in hospital mortality (25% vs. 6%; p < .001). Clinical success, MAEs, re-interventions, and pulmonary and renal complications were significantly worse in COVID patients. Independent risk factors for in hospital death were COVID (OR 4.1), medical treatment (OR 7.2), and emergency setting (OR 13.6). COVID (OR 3.4), obesity class V (OR 13.5), and emergency setting (OR 4.0) were independent risk factors for development of MAEs. CONCLUSION: During the COVID-19 pandemic in Lombardy, acute limb ischaemia was the most frequent vascular disease requiring surgical treatment. COVID-19 was associated with a fourfold increased risk of death and a threefold increased risk of major adverse events.


Subject(s)
COVID-19 , Infection Control , Postoperative Complications , Vascular Diseases , Vascular Surgical Procedures , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Emergencies/epidemiology , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Female , Hospital Mortality , Humans , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Outcome and Process Assessment, Health Care , Postoperative Complications/epidemiology , Postoperative Complications/therapy , Prognosis , Retrospective Studies , Risk Adjustment/methods , Risk Factors , SARS-CoV-2/isolation & purification , Vascular Diseases/diagnosis , Vascular Diseases/mortality , Vascular Diseases/surgery , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/methods
12.
Respir Res ; 21(1): 241, 2020 Sep 21.
Article in English | MEDLINE | ID: covidwho-781467

ABSTRACT

BACKGROUND: Patients with cardiovascular comorbidities are at high risk of poor outcome from COVID-19. However, how the burden (number) of vascular risk factors influences the risk of severe COVID-19 disease remains unresolved. Our aim was to investigate the association of severe COVID-19 illness with vascular risk factor burden. METHODS: We included 164 (61.8 ± 13.6 years) patients with COVID-19 in this retrospective study. We compared the difference in clinical characteristics, laboratory findings and chest computed tomography (CT) findings between patients with severe and non-severe COVID-19 illness. We evaluated the association between the number of vascular risk factors and the development of severe COVID-19 disease, using a Cox regression model. RESULTS: Sixteen (9.8%) patients had no vascular risk factors; 38 (23.2%) had 1; 58 (35.4%) had 2; 34 (20.7%) had 3; and 18 (10.9%) had ≥4 risk factors. Twenty-nine patients (17.7%) experienced severe COVID-19 disease with a median (14 [7-27] days) duration between onset to developing severe COVID-19 disease, an event rate of 4.47 per 1000-patient days (95%CI 3.10-6.43). Kaplan-Meier curves showed a gradual increase in the risk of severe COVID-19 illness (log-rank P < 0.001) stratified by the number of vascular risk factors. After adjustment for age, sex, and comorbidities as potential confounders, vascular risk factor burden remained associated with an increasing risk of severe COVID-19 illness. CONCLUSIONS: Patients with increasing vascular risk factor burden have an increasing risk of severe COVID-19 disease, and this population might benefit from specific COVID-19 prevention (e.g., self-isolation) and early hospital treatment measures.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Vascular Diseases/epidemiology , Aged , Betacoronavirus/pathogenicity , COVID-19 , China/epidemiology , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Female , Host-Pathogen Interactions , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Prognosis , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Time Factors , Vascular Diseases/diagnosis
13.
Med Hypotheses ; 144: 110229, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-739953

ABSTRACT

The COVID-19 pandemic caused by the SARS-CoV-2 virus has infected millions and overburdened the healthcare infrastructure globally. Recent studies show that the endothelial dysfunction caused by the virus contributes to its high morbidity and mortality. A parameter that can identify patients who will develop complications early will be valuable in patient management and reducing the burden on medical resources. An emerging technology is currently being tested to predict the cardiovascular risk via non-invasively measuring the endothelial dysfunction. This paper reviews how the assessment of endothelial dysfunction using this technology can be used as a potential parameter in the prognostication and management of COVID-19 patients.


Subject(s)
COVID-19 Testing , COVID-19/diagnosis , Comorbidity , Endothelium, Vascular/pathology , Vascular Diseases/diagnosis , COVID-19/complications , COVID-19/drug therapy , COVID-19/epidemiology , Cardiovascular Diseases , Cytokines/metabolism , Female , Humans , Immune System , Male , Nitric Oxide/metabolism , Prognosis , Risk , Treatment Outcome , Vascular Diseases/epidemiology , Vascular Diseases/virology
15.
Phlebology ; 35(8): 550-555, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-660290

ABSTRACT

The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30-90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6-12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.


Subject(s)
Coronavirus Infections/therapy , Decision Support Systems, Clinical/standards , Decision Support Techniques , Emergency Service, Hospital/standards , Lymphatic Diseases/therapy , Pneumonia, Viral/therapy , Triage/standards , Vascular Diseases/therapy , COVID-19 , Clinical Decision-Making , Consensus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Health Services Needs and Demand/standards , Humans , Lymphatic Diseases/diagnosis , Lymphatic Diseases/epidemiology , Pandemics , Patient Selection , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Vascular Diseases/diagnosis , Vascular Diseases/epidemiology
16.
Am J Respir Crit Care Med ; 202(5): 690-699, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-646801

ABSTRACT

Rationale: Clinical and epidemiologic data in coronavirus disease (COVID-19) have accrued rapidly since the outbreak, but few address the underlying pathophysiology.Objectives: To ascertain the physiologic, hematologic, and imaging basis of lung injury in severe COVID-19 pneumonia.Methods: Clinical, physiologic, and laboratory data were collated. Radiologic (computed tomography (CT) pulmonary angiography [n = 39] and dual-energy CT [DECT, n = 20]) studies were evaluated: observers quantified CT patterns (including the extent of abnormal lung and the presence and extent of dilated peripheral vessels) and perfusion defects on DECT. Coagulation status was assessed using thromboelastography.Measurements and Results: In 39 consecutive patients (male:female, 32:7; mean age, 53 ± 10 yr [range, 29-79 yr]; Black and minority ethnic, n = 25 [64%]), there was a significant vascular perfusion abnormality and increased physiologic dead space (dynamic compliance, 33.7 ± 14.7 ml/cm H2O; Murray lung injury score, 3.14 ± 0.53; mean ventilatory ratios, 2.6 ± 0.8) with evidence of hypercoagulability and fibrinolytic "shutdown". The mean CT extent (±SD) of normally aerated lung, ground-glass opacification, and dense parenchymal opacification were 23.5 ± 16.7%, 36.3 ± 24.7%, and 42.7 ± 27.1%, respectively. Dilated peripheral vessels were present in 21/33 (63.6%) patients with at least two assessable lobes (including 10/21 [47.6%] with no evidence of acute pulmonary emboli). Perfusion defects on DECT (assessable in 18/20 [90%]) were present in all patients (wedge-shaped, n = 3; mottled, n = 9; mixed pattern, n = 6).Conclusions: Physiologic, hematologic, and imaging data show not only the presence of a hypercoagulable phenotype in severe COVID-19 pneumonia but also markedly impaired pulmonary perfusion likely caused by pulmonary angiopathy and thrombosis.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Lung/blood supply , Pneumonia, Viral/complications , Pulmonary Circulation/physiology , Vascular Diseases/etiology , Adult , Aged , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Tomography, X-Ray Computed , Vascular Diseases/diagnosis , Vascular Diseases/physiopathology
17.
J Vasc Surg Venous Lymphat Disord ; 8(5): 706-710, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-628665

ABSTRACT

The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semiurgent (to be attended to within 30-90 days), example highly symptomatic chronic venous disease, and (4) discretionary/nonurgent- (to be seen within 6-12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Lymphatic Diseases/therapy , Pneumonia, Viral/epidemiology , Triage/organization & administration , Vascular Diseases/therapy , Veins , COVID-19 , Consensus , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Humans , International Cooperation , Lymphatic Diseases/diagnosis , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , Reproducibility of Results , SARS-CoV-2 , Severity of Illness Index , Societies, Medical , Vascular Diseases/diagnosis , Vascular Surgical Procedures
18.
J Vasc Surg ; 73(2): 392-398, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-628496

ABSTRACT

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.


Subject(s)
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
19.
Ann Vasc Surg ; 68: 76-82, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-601188

ABSTRACT

BACKGROUND: The aim of this pilot study was to evaluate the effectiveness and patients satisfaction of using telemedicine virtual communications to provide remote health care to vascular patients during the coronavirus disease 2019 (COVID-19) period in China. METHODS: Video calls using WeChat software (Tencent, Shenzhen, China) between patients and vascular surgeons were conducted in a period when there were restrictions and limitations for people' travels in China. At the end of each video call, a short questionnaire was used to evaluate the patient satisfaction level. RESULTS: During the COVID-19 period from 19 February to March 16, 2020, a sample of 114 from 165 (69%) patients was reached after one phone call attempt. One hundred forty-two telemedicine remote communications were made between the two vascular surgeons and 114 patients. The mean age of this cohort of patients were 60 ± 15.2 (range 25 to 90) years old, and 74 (65%) were men. Twenty-five patients (22%) were outside of our province when they received the video call. The mean duration of the video call was 11.0 ± 8.9 minutes. All of the patients thought telemedicine was a good substitute for coming to hospital, and 95% (108/114) of them preferred to have remote telemedicine rather than postpone the appointment. All the patients agreed with the advantages of telemedicine including no infection risks, no need to travel, and no need to wait for long time. All the patients were "satisfied" or "highly satisfied" with the video call and they would like to use telemedicine for follow-up in the future. CONCLUSIONS: Telemedicine virtual communications was effective to provide remote health care with a high patient satisfaction during the COVID-19 period. Telemedicine offers support to vulnerable vascular patients without the need for travel and face-to-face hospital consultation, and so avoided transmission and infection.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pandemics , Patient Satisfaction , Pneumonia, Viral/epidemiology , Referral and Consultation/organization & administration , Telemedicine/methods , Vascular Diseases/diagnosis , Video Recording/methods , COVID-19 , China/epidemiology , Comorbidity , Coronavirus Infections/diagnosis , Female , Humans , Male , Middle Aged , Pilot Projects , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Surveys and Questionnaires , Vascular Diseases/epidemiology , Vascular Diseases/therapy
SELECTION OF CITATIONS
SEARCH DETAIL