EP.WE.561The impact of COVID-19 on infra-inguinal revascularisation in patients with symptomatic peripheral occlusive arterial disease

Introduction Standard Operating Procedures were revised in response to the Covid-19 pandemic. There are descriptions from across Europe of increased rates of major extremity amputation. We have explored practice in a regional vascular unit serving two Health Boards in Scotland with specific reference to infra-inguinal revascularisation for patients with symptomatic peripheral occlusive arterial disease. Methods A retrospective review of the administrative theatre database was performed. Pre-Covid (1st April–July 31st 2019) and peri-Covid (1st April-31st July 2020) periods were examined and index cases identified. Practice and outcomes were examined. Results There was a 50% reduction in scheduled theatre sessions during the peri-Covid period. There were 100 procedures performed pre-Covid and 71 procedures performed during the peri-Covid period. The patient demographics were comparable – mean age 68-years with a male to female ratio of 1.6:1. Intervention for chronic limb threatening ischaemia was much more common in the peri-Covid period than in the pre-Covid period (94% versus 64% respectively). There was a clear change in anaesthetic practice with regional anaesthesia more commonly performed in the peri-Covid period (49% versus 12% respectively). There was no difference in the types of revascularisation performed. The 30-day mortality in the peri-Covid period was less than in the pre-Covid period (3% vs 1.4%). Conclusion The Covid-19 pandemic created imperatives that necessitated re-structure of service. Despite a reduction in theatre access we have managed to maintain a limb salvage service for patients with chronic limb threatening ischaemia.

The PRESENTATION AND OUTCOMES OF AORTOFEMORAL BYPASS SURGERY IN PATIENTS WITH AORTOILIAC OCCLUSIVE DISEASE. FOUR YEARS’ EXPERIENCE AT A TERTIARY CARE HOSPITAL

Objective: To highlight the presentation and outcomes of Aortofemoral bypass surgery at a tertiary care hospital. Study Design: Prospective observational study. Place and Duration of Study: Vascular Surgery department, Combined Military Hospital Lahore, from Jan 2015to Dec 2019. Methodology: A total of 23 patients between 50-80 years of age presenting with critical limb ischemia due toAortoiliac occlusive arterial disease type C or D of Trans-Atlantic inter Society Consensus (TASC) II classificationconfirmed on CT Angiogram, were included in the study. The clinical presentation, co-morbid illnesses, historyof smoking, obesity, post operative patency of graft, wound infection, amputation rates, and mortality weredocumented on a structured proforma. All patients were followed up at 1, 6, 12 and 24 months of surgery.Outcomes were assessed in terms of graft patency, wound infection, limb survival, amputations and mortality.Data was analyzed by SPSS version 23.0. Results: The mean age of patients was 71.04 ± 7.29 years. Most patients presented with rest pain (56.5%). Thefrequency of smokers was 78.3% while 34.8% patients had both diabetes mellitus and ischemic heart disease.Hyperlipidemia was present in 30.4% patients. Two patients (8.7%) developed superficial surgical site infection.The limb salvage rate was 95.7% and the mortality rate was 4.3%. Conclusion: Aortofemoral bypass surgery is a safe and highly effective treatment modality for the management of aortoiliac occlusive arterial disease in experienced hands. Limb salvage can be successfully achieved in more than 95% cases.Keywords: ,, ,, .

Do Surgical Site Infections in Open Aortoiliac Surgery Differ Between Occlusive and Aneurysmal Arterial Disease?

Background: Surgical site infections (SSI) are frequently seen after aortoiliac vascular surgery (2%-14%). Deep SSIs are associated with graft infection, sepsis, and mortality. This study evaluates the difference in incidence and nature of SSI following open aortoiliac surgery for aneurysmal disease compared to occlusive arterial disease. Methods: A retrospective cohort study was conducted, including all consecutive patients who underwent open aortoiliac vascular surgery between January 2005 and December 2016 in the Amphia Hospital, Breda, the Netherlands. Patients were grouped by disease type, either aneurysmal or occlusive arterial disease. Data were gathered, including patient characteristics, potential risk factors, and development of SSI. Surgical site infections were defined in accordance with the criteria of the Centers for Disease Control. Results: Between January 2005 and December 2016, a total of 756 patients underwent open aortoiliac surgery of which 517 had aortoiliac aneurysms and 225 had aortoiliac occlusive disease. The group with occlusive disease was younger, predominantly male, and had more smokers. After exclusion of 228 patients undergoing acute surgery, the SSI rate after elective surgery was 6.2%, with 10 of 301 SSIs in the aneurysmal group (3.0%) and 22 of 213 SSIs in the group with occlusive disease (10.3%, P < .001). Also, infection-related readmission and reintervention were higher after occlusive surgery, 6.6% versus 0.9% ( P < .001) and 4.2% versus 0.9% ( P = .003), respectively. Staphylococcus aureus was found as the most common pathogen, causing 64% of SSI in occlusive disease versus 10% in aneurysmal disease ( P = .005). Logistic regression showed occlusive arterial disease and chronic renal disease were associated with SSI. Conclusion: Our study presents evidence for a higher rate of SSI in patients with aortoiliac occlusive disease compared to aortoiliac aneurysmal disease, in part due to inherent use of inguinal incision in patients with occlusive disease. All precautions to prevent SSI should be taken in patients undergoing vascular surgery for arterial occlusive disease.