Outcomes After Vascular Surgery Procedures in Patients with COVID-19 Infection: A National Multicenter Cohort Study (COVID-VAS).

OBJECTIVES: To analyze the outcome of vascular procedures performed in patients with COVID-19 infection during the 2020 pandemic. METHODS: This is a multicenter, prospective observational cohort study. We analyzed data from 75 patients with COVID-19 infection undergoing vascular surgery procedures in 17 hospitals across Spain and Andorra between March and May 2020. The primary end point was 30-day mortality. Clinical Trials registry number NCT04333693. RESULTS: The mean age was 70.9 (45-94) and 58 (77.0%) patients were male. Around 70.7% had postoperative complications, 36.0% of patients experienced respiratory failure, 22.7% acute renal failure, and 22.7% acute respiratory distress syndrome (ARDS). All-cause 30-days mortality rate was 37.3%. Multivariate analysis identified age >65 years (P = 0.009), American Society of Anesthesiologists (ASA) classification IV (P = 0.004), preoperative lymphocyte count <0.6 (×109/L) (P = 0.001) and lactate dehydrogenase (LDH) >500 (UI/L) (P = 0.004), need for invasive ventilation (P = 0.043), postoperative acute renal failure (P = 0.001), ARDS (P = 0.003) and major amputation (P = 0.009) as independent variables associated with mortality. Preoperative coma (P = 0.001), quick Sepsis Related Organ Failure Assessment (qSOFA) score ≥2 (P = 0.043), lymphocytes <0.6 (×109/L) (P = 0.019) leucocytes >11.5 (×109/L) (P = 0.007) and serum ferritin >1800 mg/dL (P = 0.004), bilateral lung infiltrates on thorax computed tomography (P = 0.025), and postoperative acute renal failure (P = 0.009) increased the risk of postoperative ARDS. qSOFA score ≥2 was the only risk factor associated with postoperative sepsis (P = 0.041). CONCLUSIONS: Patients with COVID-19 infection undergoing vascular surgery procedures showed poor 30-days survival. Age >65 years, preoperative lymphocytes <0.6 (x109/L) and LDH >500 (UI/L), and postoperative acute renal failure, ARDS and need for major amputation were identified as prognostic factors of 30-days mortality.

[Informed consents readability in vascular surgery and its progress over time]. / Legibilidad de los consentimientos informados en cirugía vascular y análisis de su evolución en el tiempo.

BACKGROUND AND OBJECTIVE: Doctors provide patients the information in written form by informed consents (IC), being the readability essential in the quality of care. The primary endpoint was to analyze the readability of IC published by the Chapter of Endovascular Surgery (CCEV) of the Spanish Society of Angiology and Vascular Surgery (SEACV) in 2019, and its evolution to those published by the SEACV in 2007. MATERIALS AND METHODS: The ICs were organized by sectors and we obtained the following parameters: syllables, words, phrases, average words/phrases and syllables/words, Flesch, Flesch-Szigriszt, Fernández-Huerta and Gunning-Fog indexes, as well as the grade on the Inflesz scale. RESULTS: The Flesch index classified the CCEV consents as very difficult, and the Gunning-Fog index reflected a readability equivalent to university texts. The Flesch-Szigriszt, Fernández-Huerta indexes and Inflesz scale classified them as normal. The ICs with less readability were those referring to supra-aortic trunks (SAT) and miscellaneous in the Fernández-Huerta (P<.020 and P<.05, respectively) and Flesch-Szigriszt (P<.05) indexes. However, ICs regarding venous pathology showed a better readability in this indexes (P<.006). CCEV consents were significantly longer than SEACV consents (P=.021). In addition, there was a decrease over time in the mean value of the Fernandez-Huerta and Flesch-Szigriszt indexes (P=.002). CONCLUSIONS: Although CCEV consents had a normal readability, it has been observed a decrease in the readability indexes compared to those published in 2007 by the SEACV. In addition the length and content of the ICs should be reviewed, especially those relating to SAT and miscellaneous.

Percutaneous treatment of liver failure and acute mesenteric ischaemia.

INTRODUCTION: Synchronous embolism to the superior mesenteric artery (SMA) and coeliac axis (CA) is a rare disease. REPORT: A 67-year-old man with atrial fibrillation developed acute liver failure due to an embolic occlusion of the CA and SMA, with a severe coagulation disorder. He was successfully managed with percutaneous stent placement and an exploratory laparotomy was not needed. He remains symptom-free 1 year after the procedure, and duplex follow-up showed stent patency. CONCLUSION: Endovascular techniques in patients with liver failure, no signs of peritonism, early diagnosis and high operative risk seem feasible and should be used if possible, as first-line option.