Objective

To perform a scoping review of how patients with COVID-19 are affected by acute limb ischaemia (ALI) and evaluate the recommendations of the 2020 ESVS ALI Guidelines for these patients.

Methods

Research questions were defined, and a systematic literature search was performed following the PRISMA guidelines. Abstracts and unpublished literature were not included. The definition of ALI in this review is in accordance with the ESVS guidelines.

Results

Most identified papers were case reports or case series, although population based data and data from randomised controlled trials were also identified. In total, 114 unique and relevant papers were retrieved. Data were conflicting concerning whether the incidence of ALI increased, or remained unchanged, during the pandemic. Case reports and series reported ALI in patients who were younger and healthier than usual, with a greater proportion affecting the upper limb. Whether or not this is coincidental remains uncertain. The proportion of men/women affected seems unchanged. Most reported cases were in hospitalised patients with severe COVID-19. Patients with ALI as their first manifestation of COVID-19 were reported. Patients with ALI have a worse outcome if they have a simultaneous COVID-19 infection. High levels of D-dimer may predict the occurrence of arterial thromboembolic events in patients with COVID-19. Heparin resistance was observed. Anticoagulation should be given to hospitalised COVID-19 patients in prophylactic dosage. Most of the treatment recommendations from the ESVS Guidelines remained relevant, but the following were modified regarding patients with COVID-19 and ALI: 1) CTA imaging before revascularisation should include the entire aorta and iliac arteries; 2) there should be a high index of suspicion, early testing for COVID-19 infection and protective measures are advised; and 3) there should be preferential use of local or locoregional anaesthesia during revascularisation.

Conclusion

Although the epidemiology of ALI has changed during the pandemic, the recommendations of the ESVS ALI Guidelines remain valid. The above mentioned minor modifications should be considered in patients with COVID-19 and ALI.

中文翻译：

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编辑之选——欧洲血管外科学会 (ESVS) 2020 年根据文献范围界定审查根据 COVID-19 大流行管理急性肢体缺血的临床实践指南更新

客观的

对 COVID-19 患者如何受到急性肢体缺血 (ALI) 的影响进行范围界定审查，并评估 2020 年 ESVS ALI 指南对这些患者的建议。

方法

定义了研究问题，并按照 PRISMA 指南进行了系统的文献检索。摘要和未发表的文献不包括在内。本综述中 ALI 的定义符合 ESVS 指南。

结果

大多数确定的论文是病例报告或病例系列，尽管也确定了基于人群的数据和来自随机对照试验的数据。总共检索到 114 篇独特且相关的论文。关于 ALI 的发病率在大流行期间是增加还是保持不变的数据相互矛盾。病例报告和系列报道的 ALI 患者比平时更年轻、更健康，上肢受累的比例更大。这是否是巧合尚不确定。受影响的男性/女性比例似乎没有变化。大多数报告的病例是重症 COVID-19 住院患者。据报道，ALI 患者是 COVID-19 的首发表现。如果 ALI 患者同时感染 COVID-19，他们的预后会更差。高水平的 D-二聚体可预测 COVID-19 患者动脉血栓栓塞事件的发生。观察到肝素抗性。应以预防剂量对住院的 COVID-19 患者进行抗凝治疗。ESVS 指南中的大部分治疗建议仍然相关，但针对 COVID-19 和 ALI 患者进行了以下修改：1) 血运重建前的 CTA 成像应包括整个主动脉和髂动脉；2) 应高度怀疑，建议及早检测 COVID-19 感染并采取防护措施；3) 在血运重建期间应优先使用局部或局部区域麻醉。应以预防剂量对住院的 COVID-19 患者进行抗凝治疗。ESVS 指南中的大部分治疗建议仍然相关，但针对 COVID-19 和 ALI 患者进行了以下修改：1) 血运重建前的 CTA 成像应包括整个主动脉和髂动脉；2) 应高度怀疑，建议及早检测 COVID-19 感染并采取防护措施；3) 在血运重建期间应优先使用局部或局部区域麻醉。应以预防剂量对住院的 COVID-19 患者进行抗凝治疗。ESVS 指南中的大部分治疗建议仍然相关，但针对 COVID-19 和 ALI 患者进行了以下修改：1) 血运重建前的 CTA 成像应包括整个主动脉和髂动脉；2) 应高度怀疑，建议及早检测 COVID-19 感染并采取防护措施；3) 在血运重建期间应优先使用局部或局部区域麻醉。2) 应高度怀疑，建议及早检测 COVID-19 感染并采取防护措施；3) 在血运重建期间应优先使用局部或局部区域麻醉。2) 应高度怀疑，建议及早检测 COVID-19 感染并采取防护措施；3) 在血运重建期间应优先使用局部或局部区域麻醉。

结论

尽管 ALI 的流行病学在大流行期间发生了变化，但 ESVS ALI 指南的建议仍然有效。对于 COVID-19 和 ALI 患者，应考虑进行上述微小修改。