From the Division of Vascular Surgery, University of Ottawa at The Ottawa Hospital, Ottawa, Ont. (Strauss, Jetty); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Strauss, Seo, Carrier, Jetty); the Division of Hematology, Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Carrier); and the Ottawa Hospital Research Institute, Ottawa, Ont. (Carrier).
Can J Surg. 2021 May 12;64(3):E289-E297. doi: 10.1503/cjs.023820.
Since COVID-19 was declared a pandemic a year ago, our understanding of its effects on the vascular system has slowly evolved. At the cellular level, SARS-CoV-2 - the virus that causes COVID-19 - accesses the vascular endothelium through the angiotensin-converting enzyme 2 (ACE-2) receptor and induces proinflammatory and prothrombotic responses. At the clinical level, these pathways lead to thromboembolic events that affect the pulmonary, extracranial, mesenteric, and lower extremity vessels. At the population level, the presence of vascular risk factors predisposes individuals to more severe forms of COVID-19, whereas the absence of vascular risk factors does not spare patients with COVID-19 from unprecedented rates of stroke, pulmonary embolism and acute limb ischemia. Finally, at the community and global level, the fear of COVID-19, measures taken to limit the spread of SARS-CoV-2 and reallocation of limited hospital resources have led to delayed presentations of severe forms of ischemia, surgery cancellations and missed opportunities for limb salvage. The purpose of this narrative review is to present some of the data on COVID-19, from cellular mechanisms to clinical manifestations, and discuss its impact on the local and global surgical communities from a vascular perspective.
自一年前 COVID-19 被宣布为大流行以来，我们对其对血管系统影响的理解逐渐深入。在细胞水平上，导致 COVID-19 的 SARS-CoV-2 病毒通过血管紧张素转换酶 2（ACE-2）受体进入血管内皮，并引发促炎和促血栓形成反应。在临床水平上，这些途径导致血栓栓塞事件，影响肺部、颅外、肠系膜和下肢血管。在人群水平上，血管危险因素的存在使个体易患更严重形式的 COVID-19，而没有血管危险因素并不能使 COVID-19 患者免受前所未有的中风、肺栓塞和急性肢体缺血的影响。最后，在社区和全球层面，对 COVID-19 的恐惧、为限制 SARS-CoV-2 传播而采取的措施以及有限医院资源的重新分配，导致严重缺血形式的就诊延迟、手术取消以及肢体挽救机会的错失。本叙述性综述的目的是从细胞机制到临床表现介绍一些关于 COVID-19 的数据，并从血管角度讨论其对当地和全球外科界的影响。
