Progress in aorta and peripheral cardiovascular disease research.

Although coronavirus disease 2019 seems to be the leading topic in research number of outstanding studies have been published in the field of aorta and peripheral vascular diseases likely affecting our clinical practice in the near future. This review article highlights key research on vascular diseases published in 2020. Some studies have shed light in the pathophysiology of aortic aneurysm and dissection suggesting a potential role for kinase inhibitors as new therapeutic options. A first proteogenomic study on fibromuscular dysplasia (FMD) revealed a promising novel disease gene and provided proof-of-concept for a protein/lipid-based FMD blood test. The role of NADPH oxidases in vascular physiology, and particularly endothelial cell differentiation, is highlighted with potential for cell therapy development. Imaging of vulnerable plaque has been an intense field of research. Features of plaque vulnerability on magnetic resonance imaging as an under-recognized cause of stroke are discussed. Major clinical trials on lower extremity peripheral artery disease have shown added benefit of dual antithrombotic (aspirin plus rivaroxaban) treatment.

Perioperative SARS-CoV-2 infections increase mortality, pulmonary complications, and thromboembolic events: A Dutch, multicenter, matched-cohort clinical study.

BACKGROUND: A direct comparison of severe acute respiratory syndrome coronavirus 2 positive patients with a severe acute respiratory syndrome coronavirus 2 negative control group undergoing an operative intervention during the current pandemic is lacking, and a reliable estimate of the assumed difference in morbidity and mortality between both patient categories remains unknown. METHODS: We included all consecutive patients with a confirmed pre- or postoperative severe acute respiratory syndrome coronavirus 2 positive status (operated in 27 hospitals) and negative control patients (operated in 4 hospitals) undergoing emergency or elective operations. A propensity score-matched comparison of clinical outcomes was performed between severe acute respiratory syndrome coronavirus 2 positive and negative tested patients (control group). Primary outcome was overall 30-day mortality rate between both groups. Main secondary outcomes were overall, pulmonary, and thromboembolic complications. RESULTS: In total, 161 severe acute respiratory syndrome coronavirus 2 positive and 342 control severe acute respiratory syndrome coronavirus 2 negative patients were included in this study. The 30-day overall postoperative mortality rate was greater in the severe acute respiratory syndrome coronavirus 2 positive cohort compared with the negative control group (16% vs 4% respectively; P = .007). After propensity score matching, the severe acute respiratory syndrome coronavirus 2 positive group consisted of 123 patients (median 70 years of age [interquartile range 59-77] and 55% male) were compared with 196 patients in the matched control group (median 69 years (interquartile range 58-75] and 53% male). The 30-day mortality rate and risk were greater in the severe acute respiratory syndrome coronavirus 2 positive group compared with the matched control group (12% vs 4%; P = .009 and odds ratio 3.4 [95% confidence interval 1.5-8.5]; P = .005, respectively). Overall, pulmonary and thromboembolic complications occurred more often in severe acute respiratory syndrome coronavirus 2 positive patients (P < .01). CONCLUSION: Patients diagnosed with perioperative severe acute respiratory syndrome coronavirus 2 have an increased risk of 30-day mortality, pulmonary complications, and thromboembolic events. These findings serve as an evidence-based argument to postpone elective surgery and selected emergency cases.

Lower-extremity Arterial Thrombosis Associated with COVID-19 Is Characterized by Greater Thrombus Burden and Increased Rate of Amputation and Death.

Background During the peak of the coronavirus disease 2019 (COVID-19) pandemic, the authors noted an increase in positive lower-extremity CT angiography examinations in patients who presented with leg ischemia. The goal of this study was to determine whether lower-extremity arterial thrombosis was associated with COVID-19 and whether it was characterized by greater severity in these patients. Materials and Methods In this retrospective propensity score-matched study approved by the institutional review board, 16 patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and who underwent CT angiography of the lower extremities and 32 patients who tested negative for SARS-CoV-2 observed from January to April 2018, January to April 2019, and January to April 2020 were compared using three scoring systems: two systems including all vessels, with weighting in one system given to more proximal vessels and with weighting in the other system given to more distal vessels, and a third system in which only the common iliac through popliteal arteries were considered. Correlation with presenting symptoms and outcomes was computed. Fisher exact tests were used to compare patients who tested positive for COVID-19 with patients who tested negative for COVID-19 regarding the presence of clots and presenting symptoms. A Mantel-Haenszel test was used to associate outcome of death and/or amputation with COVID-19 adjusted according to history of peripheral vascular disease (PVD). Results Sixteen patients with confirmed COVID-19 (70 years ± 14 [standard deviation]; seven women) who underwent CT angiography and 32 propensity score-matched control patients (71 years ± 15; 16 women) were included. All patients with COVID-19 (100%, 95% confidence interval [CI]: 79%, 100%) had at least one thrombus, and only 69% of control patients (95% CI: 50%, 84%) had thrombi (P = .02). Ninety-four percent of patients with COVID-19 (95% CI: 70%, 99.8%) had proximal thrombi compared with 47% of control patients (95% CI: 29%, 65%) (P < .001). The mean thrombus score using any of the three scoring systems yielded greater scores in patients with COVID-19 (P < .001). Adjusted for history of PVD, death or limb amputation was more common in patients with COVID-19 (odds ratio = 25; 95% CI: 4.3, 147; P < .001). Patients with COVID-19 who presented with symptoms of leg ischemia only were more likely to avoid amputation or death than patients who also presented with pulmonary or systemic symptoms (P = .001). Conclusion Coronavirus disease 2019 is associated with lower-extremity arterial thrombosis characterized by a greater clot burden and a more dire prognosis. © RSNA, 2020.