Department of Vascular Surgery, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
Gloucestershire Hospitals NHS Foundation Trust, UK.
Eur J Vasc Endovasc Surg. 2022 Jan;63(1):80-89. doi: 10.1016/j.ejvs.2021.08.028. Epub 2021 Sep 6.
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.
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 Abstracts and unpublished literature were not included.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.
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.
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.
对 COVID-19 患者急性肢体缺血（ALI）的影响进行范围界定综述，并评估 2020 年 ESVS ALI 指南针对这些患者的推荐意见。
根据 PRISMA 指南定义研究问题，并进行系统文献检索。未纳入摘要和未发表的文献。本综述中 ALI 的定义与 ESVS 指南一致。
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随机对照试验的数据。共检索到 114 篇独特且相关的论文。关于大流行期间 ALI 的发病率是否增加或保持不变的数据存在冲突。病例报告和系列报告称，患有 ALI 的患者比平时更年轻、更健康，上肢受累比例更高。这是否巧合仍不确定。受影响的男女比例似乎没有变化。大多数报告的病例发生在患有严重 COVID-19 的住院患者中。报告了以 ALI 为 COVID-19 首发表现的患者。患有 ALI 的患者如果同时感染 COVID-19，其预后更差。COVID-19 患者的 D-二聚体水平较高可能预示着动脉血栓栓塞事件的发生。观察到肝素抵抗。应给予住院 COVID-19 患者预防性剂量的抗凝治疗。ESVS 指南中的大多数治疗建议仍然适用，但针对 COVID-19 和 ALI 患者进行了以下修改：1）血管再通前的 CTA 成像应包括整个主动脉和髂动脉；2）应高度怀疑 COVID-19 感染，建议早期检测并采取保护措施；3）血管再通期间应优先使用局部或局部区域麻醉。
尽管大流行期间 ALI 的流行病学发生了变化，但 ESVS ALI 指南的建议仍然有效。对于 COVID-19 和 ALI 患者，应考虑上述轻微修改。
