O-190 - ACUTE LOWER LIMB ISCHEMIA IN COVID19 PATIENTS

TOPIC:
Thrombosis
AUTHORS:
Spinelli D. (University of Messina, Dipartimento di Scienze biomediche, odontoiatriche e delle immagini morfologiche e funzionali ~ Messina ~ Italy) , Monaca G. (University of Messina, Dipartimento di Scienze biomediche, odontoiatriche e delle immagini morfologiche e funzionali ~ Messina ~ Italy) , La Corte F. (University of Messina, Dipartimento di Scienze biomediche, odontoiatriche e delle immagini morfologiche e funzionali ~ Messina ~ Italy) , Benedetto F. (University of Messina, Dipartimento di Scienze biomediche, odontoiatriche e delle immagini morfologiche e funzionali ~ Messina ~ Italy)
Introduction:
Coronavirus disease 2019 (COVID19) is a known risk factor for thrombotic events [1]. In fact, thrombotic complications have been reported in 27.6% of intensive care unit COVID19 positive patients (COVID19+) and 6.6% general ward COVID+ patients. [2] Among arterial thrombotic complications, acute limb ischemia was also reported. [3] However it is not clear wether COVID19 is associated with a worse course in terms of limb salvage and survival in acute limb ischemia patients. The aim of this study was to compare the outcomes of acute lower limb ischemia in COVID19+ patients versus acute lower limb ischemia in the general population since the start of COVID19 pandemic.
Methods:
All consecutive patients diagnosed with acute lower limb ischemia and transferred to our hospital (either the unit of vascular surgery or one of the COVID19-dedicated units) from March 2020 to February 2022 were included in this single center retrospective study. Patients with acute ischemia due to a previous bypass thrombosis or infection were excluded. Collected variables included acute limb ischemia severity (acute limb ischemia Rutherford classification) COVID19 positivity and symptoms, cardiovascular risk factors, atrial fibrillation, use of anticoagulant or antiplatelet drugs. Analysed outcomes were 30-day amputation-free survival and overall survival.
Results:
52 patients were included. Among these, 10 were COVID19 positive at the moment of diagnosis and 42 patients were COVID19 negative and formed the control group. The rutherford classification was IIA, IIB and III in 3 (30%), 3 (30%), and 4 (40%) patients in the COVID19+ group vs 16 (38%), 23 (55%), and 3 (7%) in the control group respectively. There was no significant difference between COVID19+ and control group in terms of age, sex ad cardiovascular risk factors, except for diabetes, which was overrepresented in the COVID19+ patients (60% vs 19%). 2 patients underwent primary amputation in the COVID19+ group vs no patient in the control group. Additional 2 (20%) patients in the COVID19+ group vs 6 (14%) patient in the control group underwent amputation as a consequence of failed revascularization or recurrence of limb ischemia in the post-operative course. 30-day amputation-free survival was 40% in the COVID19+ group vs 79% in the control group (p=0.024). 30-day mortality was 60% in the COVID19+ group vs 17% in the control group (p=0.009). At multivariate analysis, COVID19 (p=0.036) and diabetes (p=0.036) were associated with increased overall mortality, while only diabetes was associated with decreased amputation-free survival (p=0.003).
Conclusion:
COVID19+ patients affected by acute lower limb ischemia presented with more severe ischemia at the moment of diagnosis and showed significantly worse overall survival and amputation free survival compared with non-covid patients affected by lower limb ischemia. Diabetes was overrepresented among Covid19+ patients with acute lower limb ischemia.
References:
1) Avila J, Long B, Holladay D, Gottlieb M. Thrombotic complications of COVID-19. Am J Emerg Med. 2021 Jan;39:213-218. doi: 10.1016/j.ajem.2020.09.065. Epub 2020 Oct 1. PMID: 33036855; PMCID: PMC7528743. 2) Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, Kucher N, Studt JD, Sacco C, Bertuzzi A, Sandri MT, Barco S; Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020 Jul;191:9-14. doi: 10.1016/j.thromres.2020.04.024. Epub 2020 Apr 23. PMID: 32353746; PMCID: PMC7177070. 3) Bellosta R, Luzzani L, Natalini G, Pegorer MA, Attisani L, Cossu LG, Ferrandina C, Fossati A, Conti E, Bush RL, Piffaretti G. Acute limb ischemia in patients with COVID-19 pneumonia. J Vasc Surg. 2020 Dec;72(6):1864-1872. doi: 10.1016/j.jvs.2020.04.483. Epub 2020 Apr 29. PMID: 32360679; PMCID: PMC7188654.