29 research outputs found
Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study
Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries
Transcervical carotid artery revascularization: A systematic review and meta-analysis of outcomes
Objective: Carotid artery stenosis is considered a determinant factor
for cerebrovascular events, estimated to be the cause of 10% to 20% of
all ischemic strokes. Transcervical carotid artery revascularization
(TCAR) has been offered as an alternative to transfemoral carotid artery
stenting and carotid endarterectomy to treat carotid artery stenosis.
Methods: We performed a systematic review and meta-analysis of
prospective and retrospective studies reporting the outcomes of patients
who had undergone TCAR for carotid artery stenosis. The incidence of
periprocedural adverse events was calculated.
Results: A total of 45 studies with 14,588 patients met the predefined
eligibility criteria and were included in the present meta-analysis. The
technical success rate was 99% (95% confidence interval [CI],
98%-99%). The reasons for technical failure included an inability to
cross the lesion and/or failure to deploy the stent. Access site
complications occurred in 2% of all cases (95% CI, 1%-2%; 30
studies). Overall, the incidence of cranial nerve (CN) injuries was very
rare, with only 33 of 8994 patients experiencing neurologic deficits
attributed to CN involvement. Bleeding complications were reported by 20
studies and occurred in 2% (95% CI, 1%-3%) of all cases. The overall
periprocedural all-cause mortality and stroke rate was 0.5% and 1.3%,
respectively. In-stent restenosis was observed in 4 of 260 patients
(1.5%; 7 studies), and early (30-day) reocclusion or acute thrombosis
of the target lesion occurred in 12 of 1243 patients (w1%; 11 studies).
Conclusions: The results from the present study have provided
significant evidence that TCAR is a very promising and safe carotid
revascularization approach with favorable technical success rates
associated with low periprocedural stroke and CN injury rates
Global impact of the first coronavirus disease 2019 (COVID-19) pandemic wave on vascular services
This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. One of the most affected specialtie