Surgical treatment of acute arterial diseases in COVID-19 patients

Abstract

Objective. To study the efficiency of surgical treatment of acute arterial diseases in patients with COVID-19. Material and methods. There were 85 surgeries on the great arteries between January 2021 and October 2021. Fifty-four patients underwent 67 interventions on the lower limb arteries and 15 patients underwent 18 surgeries on the upper limb arter-ies. All patients were diagnosed with COVID-19 bilateral pneumonia and positive PCR with various CT grades of lung lesion. Indication for emergency surgical treatment was critical lower limb ischemia or acute lower limb ischemia associated with thrombosis/embolism of the main arteries. Mean age of patients was 74.4±2.2 years. Results. We performed the following interventions: thrombectomy from the lower limb arteries — 44 (51.8%) patients, endarter-ectomy from superficial femoral artery — 1 (1.1%), re-canalization and balloon angioplasty of tibial arteries — 1 (1.1%), hybrid operations — 6 (7%), thrombectomy from the upper limb arteries — 18 (21.1%), aortoiliac bifurcation replacement — 1 (1.1%), surgery for bleeding from the main arteries — 14 (16.8%) patients. All patients continued postoperative anticoagulation and an-tiplatelet therapy. In 3% of cases, we decreased amputation level to the middle third of the lower leg and preserved the knee joint. In early postoperative period, 20% of patients developed distal thrombosis with irreversible ischemia of the lower extremity that required amputation at the hip level. The mortality rate amounted to 43.4%. It was mainly associated with respiratory failure and volume of lung lesion. Conclusion. Surgical treatment of arterial thrombosis/embolism or critical ischemia is effective. However, treatment may be fol-lowed by certain complications including progression of COVID-19 viral pneumonia with respiratory failure and acute respiratory distress syndrome. Therefore, these patients require an individualized approach and collegial decision-making regarding emergency surgery. © 2023, Media Sphera Publishing Group. All rights reserved.