P-035 - REVASCULARIZATION OUTCOMES IN COVID-19 PATIENTS WITH ACUTE LOWER LIMB ISCHEMIA.

TOPIC:
Other
AUTHORS:
Desantis C. (University of Bari ~ Bari ~ Italy) , Vacca F. (University of Bari ~ Bari ~ Italy) , Zacà S. (University of Bari ~ Bari ~ Italy) , Petrone B. (University of Bari ~ Bari ~ Italy) , Angiletta D. (University of Bari ~ Bari ~ Italy) , Pulli R. (University of Florence ~ Florence ~ Italy)
Introduction:
Outcomes of COVID-19 patients with acute lower limb ischemia (ALI) seem to be poor if compared with not-infected population but data are conflicting. The aim of our experience is to evaluate different therapeutic options in the management of ALI COVID-19 patients
Methods:
From January 2020 to January 2022, 31 patients urgently underwent a revascularization intervention at our department for ALI due to either embolic/thrombotic etiology or a thrombosed popliteal aneurysm (4 tAAP pts). Patients were divided into two groups: 12 patients diagnosed with COVID-19 infection (C-19G) and 15 not-infected patients (control group,CG). Preoperative data included: demographics, Rutherford-ALI stage, ASA score, preoperative anticoagulation and the level of lesions. Peri-operative details were: type of revascularization (angioplasty with or without stenting,PTA; catheter directed thrombolysis,CDT; surgical thrombectomy,ST; thrombectomy with active aspiration,AT; femoro-popliteal bypass,BP), post-operative therapy and complications. A primary major amputation was performed in two C-19 cases for irreversible ischemia and two patients had ALI of the upper limb thus 27 patients were finally included. Early results were analyzed in terms of 30-day thrombosis, amputation and death. Follow-up results were analyzed by Kaplan-Meier curves in terms of 12-months primary and secondary patency, freedom from reintervention, amputation-free survival and overall survival. Groups were compared with log-rank test. P<0.05 was considered significant.
Results:
Mean age was of 68±13 years (C-19G:72±12, CG:65±14). The C-19G had a more advanced ischemic stage (Rutherford-ALI stage IIb or III; C-19G: 58.3%, CG:46.7%, p=.12), a poorer clinical condition (ASA score 4; C-19G:66.7%, CG:20%, p=.049) and female gender was more affected (F; C-19G: 41.7%, CG: none, p= .006). The lesions were equally distributed in both group but no tAAP affected the C-19G. C-19 cases underwent a PTA±stenting more frequently (C-19G:41%, CG: 6.7%, p=.071). Thrombolysis was the preferred approach in the CG (C-19G:25%, CG:45%, p=.28). 30-days outcomes: thrombosis rate was 14.8% (C-19G:25%, CG:6.7%, p=.18), amputation rate was 3.7% (C-19G:8.3%, CG:none, p=.25), mortality rate was 18.5% (C-19G:33.3%, CG:6.7%, p=.041). Median follow-up was 7 months, range 1-16 (C-19G: 3, 2-9; CG: 8, 1-16). At follow-up no deaths were recorded, overall primary patency was 65% (C-19G:40%, CG:74%, log-rank 1.974, p=.16), secondary patency was 87.5% (C-19G:50%, CG:100%, log-rank 3, p=.083), freedom from reintervention were 80.5% (C-19G:80%, CG:81%, log-rank 0.14, p=.70) and amputation-free survival was 90% (C-19G:50%, CG:100%, log-rank 4, p=.046).
Conclusion:
Covid-19 patients with ALI have worst outcomes in terms of 30-day mortality and amputation-free survival within 1 year from the revascularization. Patients admitted for severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) and ALI have poorer clinical conditions and the general inflammatory state may impact on outcomes. Females seem to be more prone to develop ALI during the COVID-19 infection.