Vascular surgeons have been urged to support the health of the entire U.S. population “by immediately reducing resource expenditure, avoiding all surgical admissions unless immediately life or limb threatening and, most importantly, by staying home.”
The advisory came in a March 23 statement from the Vascular and Endovascular Surgery Society (VESS) on COVID-19, designed to help providers understand changes being put in place to allow widespread use of telemedicine in order that specialists can continue to treat patients—but also mitigate exposure risk.
The VESS executive committee, the statement reads, “supports the decision of surgical providers to rapidly curtail surgical services in response to the public health threat posed by COVID-19 patients to overwhelm hospital resources in the next weeks.”
It continues: “Some of our members have reached out for guidance regarding elective vascular surgery cases that can be safely postponed but are not specifically mentioned in other guideline documents. Many of these clinical decisions might be local or regional.
“VESS would like to serve as a resource for its members asked by respective administrators how to best provide vascular surgical care. A number of medical centers have already temporarily ceased performing elective procedures. For centers that have asked vascular surgeons to identify procedures that can be safely postponed, we would like to share examples of case types being deferred at many medical centers to make resources available to fight COVID-19.”
The statement ran through some of the types of cases that might be considered elective:
- Asymptomatic aortic aneurysms
- Asymptomatic peripheral or visceral aneurysms
- Hemodialysis access in patients with a functioning central venous catheter or who are not yet on hemodialysis
- Revascularization for chronic peripheral artery disease in the absence of tissue loss
- Any treatments for claudication
- Asymptomatic carotid disease
- Chronic mesenteric ischemia
- IVC filter retrieval
- Varicose vein procedures
- Thoracic outlet operations and compression syndrome operations
- Spine exposures
The VESS statement went on: “Vascular surgeons are also being asked to make key decisions related to inpatient and outpatient care to minimize risk to both patients and healthcare personnel. VESS supports vascular surgeons leading these critical decisions that affect our patients.
“We acknowledge that local resources—including availability of beds, blood, imaging, and support staff, etc.—are critical considerations, and the situation is changing hourly at many hospitals.”
The society also delved into considerations specific to vascular surgery practice that may not be covered in other guidelines:
- Avoiding noninvasive vascular lab testing on inpatients when clinical suspicion is low or results are unlikely to change management
- Deferring clinic visits (including telehealth visits) for patients for whom imaging is necessary to make treatment and/or follow up decisions but is temporarily unavailable.
- Substitution of telehealth visits for in-person clinic visits and inpatient consultations whenever practical and useful for the patient
- In-person evaluation should be reserved only for those patients that have signs or symptoms suggesting they may need urgent or emergent treatment