• Hany Zayed, Mustafa Musajee, Narayanan Thulasidasan, Mohamed Sayed, Federica Francia, Meryl Green, Martin Arissol, Alpa Lakhani, Lukla Biasi, and Sanjay Patel.
• Department of Vascular Surgery, Guy's and St. Thomas' NHS Foundation Trust, London SE1 7EH, United Kingdom.
• Ann. Surg. 2022 Jun 1; 275 (6): 103710421037-1042.

ObjectiveExamine the impact of COVID-19 pandemic on the outcomes in patients with CLTI or DFI.BackgroundPatients with CLTI and/or DFI are at risk of amputations if not treated in a timely manner.MethodsWe compared the outcomes in patients with CLTI or DFI during 2 periods; Period 1[P1] (15/03/2019-31/05/2019) and period 2[P2] (15/03/ 2020-31/05/2020- corresponding to COVID-19 pandemic).ResultsOne hundred thirty-nine patients were treated in P1 [mean age 70 years (±11), Male:Female = 102:37] whereas 95 patients were treated in P2 [mean age 67 (±12), Male:Female = 64:31]. The 2 cohorts were matched regarding Rutherford category (P = 0.25) and GLASS classification (P = 0.38). Notably, the time from onset of symptom to clinical presentation was significantly longer [31 (1-105) days vs 27 (0-78) days, (P = 0.017)], whereas the time from presentation to first intervention was significantly shorter [3 (0-61) days vs 5 (0-65) days, (P = 0.013)] in P2 compared to P1. There was a significantly higher white cell count (P = 0.014) and CRP (P = 0.004) on admission in P2. Having treatment for CLTI or DFI in P2 was an independent predictor of worse primary patency rate and freedom from major adverse limb events. At 90 days, amputation-free survival and limb salvage were noticeably worse in P2 compared to P1 (amputation-free survival was 80% and 87% whereas limb salvage was 64% and 72% in P2 and P1, respectively).ConclusionsPatients with CLTI and DFI experienced a significantly delayed presentation with features of sepsis on admission in P2. Treatment in P2 was a predictor of worse primary patency and freedom from major adverse limb events and therefore close and long follow-up is advisable.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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