Analysis Of Outcomes In Acute Limb Ischemia Patients During Covid-19 State Of Emergency In Western Massachusetts
Margaret Siu, MD, Alex Lin, MD, Vincent Narvaez, MD, Aixa Perez, MS, MPH, Marc Norris, MD, Matthew Kronick, MD, Neal Hadro, MD, Marvin Morris, MD.
Baystate Medical Center, Springfield, MA, USA.
OBJECTIVES: Due to effects on macrovascular and microvascular compromise, COVID-19 renders thrombotic complications in both arterial and venous supply. The clinical outcomes in vascular surgery is an ongoing area of interest. To that aim, we compared severity of patients presenting with acute limb ischemia (ALI) before, during, and following the Massachusetts COVID-19 State of Emergency(SOE) declaration. Patient acuity is quantified by anatomical arterial occlusion, Rutherford Score, intervention received, and morbidity/mortality. METHODS: A retrospective cohort study was conducted in a single Massachusetts institution on ALI patients identified by vascular procedure CPT code between 12/9/2019 -3/9/2020 designated as prior to SOE period, 3/10/2020 - 5/10/2020 designated as SOE period, and 5/11/2020- 7/31/2020 designated as post-SOE period. Demographics, ALI Rutherford score, anatomical vascular occlusion, revascularization intervention method, COVID-19 testing, and mortality were collected. Analysis was completed using ANOVA and Chi-squared and differences in characteristics between study groups were presented. Multivariate logistic regression was performed to control for confounding variables. RESULTS: There was a total of 65 subjects; 25 for pre-SOE, 19 for during SOE, and 21 for post-SOE. There was no statistical significant difference between patient demographics and comorbidities in each group (p>0.05). Class III Rutherford scores were higher during and post-SOE at 36.8% and 38.1% compared to 8.0% prior to SOE(p<0.05); Class IIa/IIb decreased during those periods(p<0.05). Multilevel arterial disease identified during and post SOE were 26.3% and 42.9% compared to prior to SOE 8.0% (p<0.05). Above knee amputations significantly increased during(15.8%) and post SOE(33.3%), as compared to pre-SOE period(4%, p<0.05). Difference in mortality was not significant among the study groups(p>0.05) (Figure 1). During SOE, there was also statistically significant increase substance use with 31.6% versus 8.0% prior and 4.8% post (p<0.05). Multivariate regression analysis showed SOE to be an independent risk factor for all amputations (OR: 6.39, 95%CI: 1.155-35.349). CONCLUSIONS: Covid-19 manifestations on healthcare and vascular surgery in particular are of ongoing concern and interest. During COVID-19 SOE, patients are potentially less likely to seek medical attention. When ALI patients do present however, their acuity is greater as shown by increased involvement of multilevel disease and more likely to require amputations. 
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