After nearly 18 months of life dominated by a worldwide pandemic—one that canceled the 2020 Vascular Annual Meeting (VAM)—VAM 2021 highlights several aspects of COVID-19 in a special session.
The coronavirus session will be from 5 to 6:30 p.m. Wednesday and includes both invited talks on COVID-related topics and presentation of several COVID-related abstracts. Vikram Kashyap, MD, Benjamin W. Starnes, MD, Maureen Sheehan, MD, Scott Damrauer, MD, Misty Humphries, MD, and Michael Rohrer, MD, will moderate.
“When we began planning sessions for this year’s meeting, we knew that the many impacts of COVID-19 that we saw during the course of the pandemic had to have a place at the podium,” said Andres Schanzer, MD, who co-chairs the Society for Vascular Surgery (SVS) Program Committee, which plans educational programming at VAM. “COVID affected virtually everything in our lives,” he said. “There were significant worries about our health and that of our patients, families and colleagues. And on top of that, there were financial concerns.”
Then there were concerns about how this never-before-seen virus affected patients already suffering from vascular diseases, he said. “Did our patients delay seeking help for their conditions? Could institutions change protocols for the better? Did catching COVID-19 further impact or exacerbate our patients negatively? “There’s so much we and other physicians, surgeons, and researchers don’t know yet. We wanted to shine a light on some of the ongoing research.”
The first four presentations are discussions. “Quantifying the financial impact of COVID on vascular surgery practices: How to recover,” by Francesco A. Aiello, MD, of the University of Massachusetts Medical School in Worcester, will kick things off.
“Global vascular surgeons’ experience, stressors and coping during the COVID-19 pandemic,” by Sherene Shalhub, MD, of the University of Washington in Seattle will follow. “Wellbeing of the vascular surgery workforce during the pandemic,” will be delivered by Max Wohlauer, MD, from the University of Colorado in Denver, who is a member of the SVS Wellness Task Force.
“Arterial thrombotic complications of COVID-19: What are they and how should they be managed?” are the questions being posed by Peter L. Faries, MD, of Mount Sinai Health System in New York.
There then follows a series of scientific talks detailing various aspects of the pandemic that hit vascular surgery practice.
The first is “Increased stroke severity, ST-elevation myocardial infarction, type A aortic dissection, and deaths at home in an early epicenter of the COVID-19 pandemic.” Researchers, including presenting author Clayton J. Brinster, MD, senior staff surgeon at Ochsner Medical Center in New Orleans, delved into the extended impact of delays in acute care during the pandemic, evaluating the ongoing effect on cardiovascular pathology.
This first analysis of ongoing stroke severity during the pandemic showed significantly worse stroke data throughout a network of 50-plus hospitals. The findings substantiated national concern that patients continued to delay care in the COVID-19 era, leading to increasingly severe, acutely symptomatic presentations and potentially preventable morbidity and mortality. The second is entitled “Outpatient chronic anticoagulation improves outcomes in patients with COVID-19 and cardiovascular risk factors.” This retrospective analysis tested if patients who contracted COVID-19 while already receiving outpatient chronic therapeutic anticoagulation would see reduced complications. The study observed that certain higher-risk individuals had notably lower rates of hospital/ICU [intensive care unit] admission, multi-system organ failure and ICU mortality. It is being delivered by Mohamed A. Zayed, MD, associate professor of surgery and radiology at Washington University School of Medicine in St. Louis.
PAD and COVID-19
Next up is “Clinical outcomes in peripheral artery disease [PAD] with COVID-19: A multicenter research network study,” from presenting author Danielle J. Kim, PhD, of Penn State Hershey College of Medicine in Hershey, Pennsylvania, and colleagues. The team of researchers examined the clinical outcomes of COVID-19 patients with PAD to determine if they are at increased risk of mortality, hospitalization and ventilator dependence. In general, COVID-19 patients with PAD have a lower survival probability, a higher rate of hospital admission and a higher likelihood of being on a ventilator compared to COVID-19 patients without PAD, she will tell VAM attendees. Even after adjusting for comorbidities and confounding factors, COVID-19 patients with PAD versus those without had a higher chance of being admitted to hospital, suggesting PAD is an important risk factor for the short-term hospital admission rate amid COVID-19, Kim et al concluded.
The CLOT calculator
“The CLOT (COVID-19 likelihood of thrombosis) calculator: Predicting venous thromboembolism (VTE) risk in hospitalized patients with COVID-19” will then be presented by Richard A. Meena, MD, an integrated vascular surgery resident at Emory University in Atlanta. Meena and a team of investigators developed a risk model (CLOT) to help clinicians predict which COVID-19 patients are more prone to VTE development, as such a development is independently associated with mortality in hospitalized COVID-19 patients. CLOT can help with risk stratification for VTE development among COVID-19 admissions and better inform clinical decision-making regarding institutional antithrombotic protocols to reduce bleeding risk and improve outcomes, Meena will inform attendees.
Jorge A. Miranda, MD, a resident at Baylor College of Medicine in Houston, will deliver a presentation entitled “Impact of COVID-19-related delays of scheduled operations in patients with chronic limb-threatening ischemia.” The talk is the result of work by Miranda and a team of researchers who sought to determine influential characteristics of a population with severe PAD/chronic limb threatening ischemia (CLTI) during the pandemic where postponement of scheduled procedures may have impacted outcomes. The delays for these patients led to “a low observed, yet unpredictable rate of decompensation,” they found. But outcomes were “catastrophic,” with a 50% risk of major amputation, for patients who saw their planned, elective surgeries converted to an emergency operation.
The last of the scientific talks is “Results of a modified lower-extremity venous duplex ultrasound protocol for patients with COVID-19,” being presented by Jessie Ho, MD, a resident at Northwestern University Feinberg School of Medicine in Chicago. COVID-19 can increase the risk of venous thromboembolism, for which timely and accurate diagnosis is crucial, Ho and colleagues report. Because sonographers performing lower-extremity venous duplex ultrasound (LEVDUS) in this setting are in close proximity to such patients for an extended length of time, sonographers subsequently face an increased risk for exposure. To balance patient care needs while minimizing sonographer risk, in March 2020 a division at Northwestern Medicine instituted a modified LEVDUS protocol for patients with suspected or confirmed COVID-19: If an acute deep vein thrombosis (DVT) was detected, the test could be terminated early. Preliminary results showed the modified protocol reduces time sonographers spend with COVID-19 patients.