Revascularization Outcomes in COVID-19 Patients With Acute Lower Limb Ischemia

Objectives: The outcomes of COVID-19 (coronavirus disease 2019) pa- tients with acute lower limb ischemia (ALI) seem poor compared with those without COVID-19; however, the data are conflicting. Our aim was to evaluate different therapeutic options in the management of ALI in pa- tients with COVID-19. Methods: From January 2020 to January 2022, 27 patients were ur- gently admitted at our department for ALI due to either an embolic/ thrombotic etiology or a thrombosed popliteal artery aneurysm (tPAA). The patients were divided into two groups: 12 patients with COVID-19 infection (C-19) and 15 patients without COVID-19 (control group [CG]). The preoperative data included demographics, Rutherford ALI stage, American Society of Anesthesiologists class, preoperative anticoagulation use, and level of the lesions. The perioperative details were revasculariza- tion type (percutaneous transluminal angioplasty [PTA] with or without stenting, catheter-directed thrombolysis, surgical thrombectomy, throm- bectomy with active aspiration, femoropopliteal bypass), postoperative therapy, and complications. PTA with or without stenting was performed when delayed revascularization (>72 hours) occurred and bypass was performed for tPAA treatment. A primary major amputation was per- formed in two C-19 cases for irreversible ischemia; thus, 25 patients were finally included. Early results were analyzed in terms of 30-day thrombosis, amputation, and death. The follow-up results were analyzed by Kaplan-Meier curves in terms of 12-month primary and secondary patency, freedom from reintervention, amputation-free survival, and over- all survival. Two groups were compared using the log-rank test. P < .05 was considered significant. Results: The mean age was 66 6 14 years (C-19 group, 75 6 12 years; CG, 65 6 14 years). The C-19 group had a more advanced ischemic stage (Rutherford ALI stage IIb or III; C-19 group, 58.3%; CG, 46.5%; P ¼ .12) and poorer clinical condition (American Society of Anesthesiologists class 4; C-19 group, 66.7%; CG, 20%; P ¼ .049), and women were more affected (C-19 group, 41.7%; CG, 0%; P ¼ .006). The lesions were equally distributed in both groups but no tPAAs affected the C-19 group. The C-19 group had undergone PTA with or without stenting more frequently (C-19 group, 41%; CG, 6.7%; P ¼ .071). Thrombolysis was the preferred approach in the CG (C-19 group, 25%; CG, 45%; P ¼ .28). The 30-day outcomes wereas follows: thrombosis rate, 16% (C-19 group, 30%; CG, 6.7%; P ¼ .11); amputation rate, 4% (C-19 group, 10%; CG, 0%; P ¼ .21); and mortality rate, 20% (C-19 group, 40%; CG, 6.7%; P ¼ .041). The median follow-up was 7 months (range, 1-16 months). At follow-up, no patient had died, the overall primary patency was 65% (C-19 group, 40%; CG, 74%; log- rank test, 1.974; P ¼ .16), secondary patency and freedom from reintervention were both 80.5% (C-19 group, 80%; CG, 81%; log-rank test, 0.14; P ¼ .70), and amputation-free survival was 90% (C-19 group, 50%; CG, 100%; log-rank test, 4; P ¼ .046). Conclusions: COVID-19 patients with ALI had worse outcomes in terms of 30-day mortality and amputation-free survival within 1 year after revas- cularization. Patients admitted for COVID-19 and ALI had poorer clinical conditions with a delay between diagnosis and intervention compared with patients with ALI but without COVID-19. These factors could affect therapeutic decisions and outcomes