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

Groin wound infection after vascular exposure ( GIVE ) multicentre cohort study

Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality, and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI. An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow‐up was 90 days. The primary outcome was the incidence of groin wound SSI. 1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 versus 5 days, P = .005), a significantly higher rate of post‐operative acute kidney injury (19.6% versus 11.7%, P = .018), with no significant difference in 90‐day mortality. Female sex, Body mass index≥30 kg/m2, ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft, or prosthetic), and increased operative time were independent predictors of SSI. Groin infections, which are clinically apparent to the treating vascular unit, are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non‐modifiable variables

Case Report - A simple method of closing an iatrogenic subclavian arterial puncture

Central venous catheters are the mainstay in the intensive management of surgical patients today and they have increasingly been applied in different medical specialties and for different clinical indications. It is generally safe to place central venous catheters using anatomic landmarks alone, but there are some possible immediate, early, and late complications related to the implantation technique. One particularly dangerous vascular complication is inadvertent arterial sheath placement. When this occurs in a site that is anatomically non-compressible, sheath removal can necessitate surgery or exposure to a significant risk of haemorrhage with manual pressure. We report a case of a sheath that was inadvertently placed in the subclavian artery and was successfully removed using a percutaneous vascular closure device

Case Report - A simple method of closing an iatrogenic subclavian arterial puncture

Central venous catheters are the mainstay in the intensive management of surgical patients today and they have increasingly been applied in different medical specialties and for different clinical indications. It is generally safe to place central venous catheters using anatomic landmarks alone, but there are some possible immediate, early, and late complications related to the implantation technique. One particularly dangerous vascular complication is inadvertent arterial sheath placement. When this occurs in a site that is anatomically non-compressible, sheath removal can necessitate surgery or exposure to a significant risk of haemorrhage with manual pressure. We report a case of a sheath that was inadvertently placed in the subclavian artery and was successfully removed using a percutaneous vascular closure device