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. 2023 Jul 19;11(7):2034.
doi: 10.3390/biomedicines11072034.

Understanding the Impact of COVID-19 on Angioplasty Service and Outcome of Patients Treated for Chronic Limb-Threatening Ischaemia: A Single-Centre Retrospective Cohort Study

Alexander D Rodway  1   2 , Jenny Harris  3 , Lydia Hanna  4 , Charlotte Allan  1 , Felipe Pazos Casal  1 , Ciara Giltinan  1   5 , Ali Dehghan-Nayeri  1   5 , Andre Santos  1   5 , Martin B Whyte  5 , Nikolaos Ntagiantas  1   6 , Ivan Walton  1   6 , Richard Brown  1 , Simon S Skene  5 , Ajay Pankhania  1 , Benjamin C T Field  1   5 , Gary D Maytham  1   6 , Christian Heiss  1   5
Affiliations

Understanding the Impact of COVID-19 on Angioplasty Service and Outcome of Patients Treated for Chronic Limb-Threatening Ischaemia: A Single-Centre Retrospective Cohort Study

Alexander D Rodway et al. Biomedicines. .

Abstract

We evaluated the impact of COVID-19 restriction on the angioplasty service and outcome of chronic limb-threatening ischaemia (CLTI) patients undergoing lower-limb angioplasty in a UK secondary care setting. Consecutive patients were analysed retrospectively. Pre-COVID-19 (08/2018-02/2020), 106 CLTI patients (91% Fontaine 4; 60% diabetes mellitus) and during COVID-19 (03/2020-07/2021) 94 patients were treated (86% Fontaine 4; 66% diabetes mellitus). While the average monthly number of patients treated did not change, the proportion of day cases significantly increased (53% to 80%), and hospitalised patients decreased. Patients treated in ≤14/5 days after referral significantly increased to 64/63%. Kaplan-Meier survival analysis (30-day/1-year) showed that neither wound healing nor mortality were significantly changed during COVID-19. In day cases, 1-year but not 30-day major amputations significantly increased, and clinically driven target-lesion revascularisation decreased during COVID-19. One-year mortality was significantly worse in hospitalised compared to day cases (14% vs. 43%) at similar wound healing rates (83% vs. 84%). The most frequent known cause of death was infectious disease (64%), while cardiovascular (21%) was less frequent. Despite COVID-19 restrictions, a safe and effective angioplasty service was maintained while shortening waiting times. Very high mortality rates in hospitalised patients may indicate that CLTI patients need to be referred and treated more aggressively earlier.

Keywords: critical limb ischaemia; day-case angioplasty; peripheral artery disease.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Evolution of numbers of patients who underwent endovascular revascularisations at Surrey and Sussex Healthcare NHS Trust 07/2018–07/2021.
Figure 2
Figure 2
Kaplan–Maier survival analysis for 1-year wound healing (A,B) and survival (C,D) pre-COVID-19 (A,C) and during COVID-19 (B,D).
Figure 3
Figure 3
Cause of death pre- and during COVID-19 periods (n = 28 and n = 20) as noted on medical examiner’s report.
Figure 4
Figure 4
Kaplan–Maier survival analysis for 1-year major amputation (A,B) and clinically driven target-lesion revascularisation (TLR; C,D) pre-COVID-19 (A,C) and during COVID-19 (B,D).
See this image and copyright information in PMC

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