Covid-19 (SARS Cov-2) was confirmed a pandemic by the World Health Organisation (WHO) on 12th March 2020. It is now recognised that infection produces a hyper-coagulable state. This study aimed to examine the demographics, covid-19 infection status, covid-19 vaccination status, treatment approaches and outcomes for patients presenting with embolic or thrombotic acute limb ischaemia that underwent an emergency embolectomy in a single UK center in a 24 month period during the covid-19 pandemic (January 2020-December 2021). Comparisons were then made with a 24 month period prior to the arrival of the pandemic (January 2018- December2019) in the same UK center.

Theatre management system (TMS) was used to identify all patients that underwent an emergency embolectomy for embolic or thrombotic acute limb ischaemia within the Royal Victoria Hospital, Belfast between January 2020 - December 2021 and January 2018 - December 2019 . Patients that underwent embolectomy for acute limb ischaemia post rupture/elective AAA repair were excluded. Data was collated using retrospective chart review and review of electronic care records. A positive PCR test for SARS COV-2 at time of presentation was deemed to confirm current covid-19 infection. Data was analysed using SPSSv25 (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp).

Eighty-three emergency embolectomies were performed in this single center from January 2020-December 2021. Thirteen patients (16%) had PCR confirmed SARS COV-2 infection at presentation. Two patients that tested negative pre-operatively were confirmed as positive at ward level post-operatively. Six patients proceeded to theatre without PCR testing and 64 patients were PCR negative. Twelve patients were vaccinated (11 Astrazena 1 Pfizer), 27 patients unvaccinated and 44 patients vaccination status was unknown. Mean age at time of surgery was 67 years (SD+/-13). Five patients were recorded as having another risk factor for developing acute embolic/thrombolic disease (eg underlying malignancy, diabetic ketoacidosis) all of whom tested negative for covid-19 at presentation. Revascularisation was successful in 94% of patients. Five patients (6%) proceeded to major amputation post-operatively. During the pre-pandemic period investigated, 68 embolectomies were performed in this single UK center. Mean age at time of surgery was 70 years (SD+/-15)) (t=1.1, df 151, p=0.2). Four patients (6%) proceeded to major amputation post-operatively. Co-exisiting co-morbidity was comparable between the two cohorts investigated.

In conclusion, there was an 18% increase in emergency embolectomy for embolic or thrombotic acute limb ischaemia in this single center during the covid-19 pandemic. 16% of patients who underwent emergency embolectomy during the pandemic had PCR confirmed covid-19 infection at presentation. Mean age, co-morbidities, other risk factors for developing acute embolic/thrombotic disease and rate of major amputation post-operatively were comparable between the two cohorts investigated. This is a single institution study and a larger observational study would be useful to ascertain if these findings are representative of other European units. Additionally, a cross-sectional study of this kind can only imply association, not causation. However, findings here would suggest that the covid-19 pandemic has increased the volume of work for vascular surgeons with an increased number of patients presenting with acute limb ischaemia and proceeding to emergency embolectomy.