Impact of the COVID-19 Pandemic on Vascular Surgery Services in a United Kingdom Tertiary Center

Abstract

Background: The COVID-19 pandemic significantly disrupted vascular surgery services worldwide. This study evaluates its impact on a UK tertiary vascular surgery center across successive lockdown phases.

Methods: A retrospective observational study compared vascular service activity across four time periods: pre-COVID-19 (P1; March 23-May 31, 2019), first lockdown (L1; March 23-May 31, 2020), second lockdown (L2; November 5-December 2, 2020), and third lockdown (L3; January 6-March 8, 2021).

Results: A total of 138 procedures were performed during P1, dropping to 42 in L1 and 35 in L2 (p < 0.03), before partially recovering to 86 in L3. Fourteen patients were COVID-19-positive, of whom 70% presented with arterial thrombosis. Aortic aneurysm repairs declined during L1 and L2 but rose significantly to 19 in L3. Thromboembolectomies doubled in all lockdowns compared to P1 (p < 0.05). Major amputations and emergency bypasses peaked during L3. Outpatient consultations fell sharply in L1 and L2 (p < 0.03), while telemedicine use increased tenfold by L3 (p < 0.05). All-cause mortality remained stable across all periods.

Conclusions: The COVID-19 pandemic profoundly affected elective vascular services while increasing emergency interventions. These findings highlight the need for resilient service structures and proactive strategies to maintain essential vascular care during future healthcare crises.

Keywords: covid-19; emergency surgery; pandemic; service disruption; vascular surgery.

Figure 1. Vascular surgery interventions and COVID-19-positive vascular patients

(A) Distribution of vascular interventions across the four study periods (P1, L1, L2, and L3). The number of interventions decreased sharply during L1 and L2 (p < 0.0001 for both, Wilcoxon matched-pairs signed-rank test) but recovered to 86 procedures during L3 (p < 0.0001). (B) Number of COVID-19-positive patients during the three UK lockdowns, with eight patients identified during the first pandemic wave; ten patients presented with COVID-19-related thrombosis. *p < 0.05.

Figure 2. Aortic interventions during the COVID-19 pandemic

(A) The number of aortic interventions declined during the first (from 10 to 4) and second lockdowns (6 repairs) but recovered in the third lockdown (19 procedures; p = 0.009). (B) Open and endovascular aortic aneurysm repairs were comparable before and during the first and second lockdowns, whereas in the third phase, EVAR was performed more frequently than open surgery (14 vs. 5 repairs; p = 0.04). AAA: abdominal aortic aneurysm, TAAA: thoraco-abdominal aortic aneurysm. *p < 0.05.

Figure 3. Lower limb revascularization before and during the COVID-19 pandemic

(A) Total lower limb revascularization procedures declined from pre-COVID to the first lockdown (13 vs. 9) and recovered to 13 in the third lockdown. (B) Common femoral endarterectomies decreased during the first lockdown (p = 0.008) and gradually recovered in later phases, similar to lower limb bypass procedures, which dropped from 14 to 9 before recovering to 14 in L3. Emergency embolectomies doubled during the lockdown periods. (C) Non-elective bypass procedures increased during COVID-19 (6-10 operations), whereas elective procedures were temporarily halted in the first lockdown (p = 0.005) and partially recovered to four in L3. CFE: common femoral endarterectomy.

Figure 4. Lower limb amputations, carotid disease interventions, mortality, and outpatient consultations during COVID-19

(A) Lower limb amputations halved from P1 to L2 (15 vs. 6, p = 0.0008), then increased sharply in L3 (6 vs. 23, p < 0.0001). (B) Major and minor amputations both declined during early lockdowns and rose again in L3 (major: 8 in P1 vs. 16 in L3, p < 0.0001; minor: 3 in L2 vs. 7 in L3, p = 0.02). (C) Carotid endarterectomies dropped by one-third during the pandemic (10 in P1 vs. 3 in L1, p = 0.0003). (D) All-cause mortality remained stable throughout the pandemic (8 total deaths), including 2 COVID-19-related fatalities. (E) Telemedicine consultations increased markedly during the lockdowns, rising from 10 in P1 to 98 in L3 (p < 0.05). *p < 0.05.