Outcomes of Vascular and Endovascular Interventions Performed During the Coronavirus Disease 2019 (COVID-19) Pandemic The Vascular and Endovascular Research Network (VERN) COVID-19 Vascular Service (COVER) Tier 2 Study

Objective: The aim of the COVER Study is to identify global outcomes and decision making for vascular procedures during the pandemic. Background Data: During its initial peak, there were many reports of delays to vital surgery and the release of several guidelines advising later thresholds for vascular surgical intervention for key conditions. Methods: An international multi-center observational study of outcomes after open and endovascular interventions. Results: In an analysis of 1103 vascular intervention (57 centers in 19 countries), 71.6% were elective or scheduled procedures. Mean age was 67 +/- 14 years (75.6% male). Suspected or confirmed COVID-19 infection was documented in 4.0%. Overall, in-hospital mortality was 11.0% [aortic interventions mortality 15.2% (23/151), amputations 12.1% (28/232), carotid interventions 10.7% (11/103), lower limb revascularisations 9.8% (51/521)]. Chronic obstructive pulmonary disease [odds ratio (OR) 2.02, 95% confidence interval (CI) 1.30-3.15] and active lower respiratory tract infection due to any cause (OR 24.94, 95% CI 12.57-241.70) ware associated with mortality, whereas elective or scheduled cases were lower risk (OR 0.4, 95% CI 0.22-0.73 and 0.60, 95% CI 0.45-0.98, respectively. After adjustment, antiplatelet (OR 0.503, 95% CI: 0.273-0.928) and oral anticoagulation (OR 0.411, 95% CI: 0.205-0.824) were linked to reduced risk of in-hospital mortality. Conclusions: Mortality after vascular interventions during this period was unexpectedly high. Suspected or confirmed COVID-19 cases were uncommon. Therefore an alternative cause, for example, recommendations for delayed surgery, should be considered. The vascular community must anticipate longer term implications for survival.

Automated summary

The mortality rate after vascular interventions during the pandemic was unexpectedly high, with suspected or confirmed COVID-19 cases being uncommon. Chronic obstructive pulmonary disease and active lower respiratory tract infection were associated with mortality, while elective procedures had lower risk. Antiplatelet and oral anticoagulation were linked to reduced risk of in-hospital mortality.