The negative effects of reduced attention to standard guidelines for screening and surgery of abdominal aortic aneurysms during the coronavirus disease 2019 pandemic.

We read with interest the article by Sullivan et al.1Sullivan K. Mureebe L. Huffman K. Eldrup-Jorgensen J. Lemmon G.W. Preliminary analysis of coronavirus disease 2019 variable insertion into Vascular Quality Initiative registries.J Vasc Surg. 2022; (Online ahead of print)https://doi.org/10.1016/j.jvs.2022.06.009Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar The authors analyzed the Society for Vascular Surgery Vascular Quality Initiative registry from September 2020 to February 2021,2Natarajan J.P. Mahenthiran A.K. Bertges D.J. Huffman K.M. Eldrup-Jorgensen J. Lemmon G.W. Effects of coronavirus disease 2019 on the Society for Vascular Surgery Vascular Quality Initiative arterial procedure registry.J Vasc Surg. 2021; 73: 1852-1857Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar,3Johnston L.E. Robinson W.P. Tracci M.C. Kern J.A. Cherry K.J. Kron I.L. et al.Vascular Quality Initiative and National Surgical Quality Improvement Program registries capture different populations and outcomes in open infrainguinal bypass.J Vasc Surg. 2016; 64: 629-637Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar finding that the elective-nonelective rates of operations were not significantly different from the historical value supposing little restriction in the performance of elective procedures. We have analyzed the number of patients who had surgery for ruptured abdominal aortic aneurysm (rAAA) in Pavia in the 2 years of the pandemic (February 2020-February 2022). Twenty-seven patients underwent surgery for rAAA. During the first year, 18 patients had surgery similarly to the previous 10 years (mean, 18.9 patients per year). In the second year of the pandemic, only nine patients had surgery for rAAA. We analyzed the number of patients who had surgery during the outbreak (14 months) and during the no-outbreak periods (10 months). In the 2 years of the pandemic, seven patients underwent surgery during the outbreak. In the same months of the previous 10 years, the mean of operated patients for rAAA was 32 every 2 years. During the no-outbreak periods (10 months), 20 patients underwent surgery with an increase of 25% in comparison with the mean of the same period of the previous 10 years (16 patients every 2 years) (P < .01) (Table).TablePrevalence of surgery for ruptured abdominal aortic aneurysms during the outbreak and no-outbreak periods of coronavirus disease 2019 (COVID-19) infection in comparison with previous years (P <.001)2010-20192020-2022Total18927COVID-19 outbreak periods Autumn73 (38.6)4 (14.8) Winter50 (26.5)3 (11.1)No COVID-19 outbreak periods Spring43 (22.7)11 (40.7) Summer23 (12.2)9 (33.3)Values are number (%). Open table in a new tab Values are number (%). Of the 27 patients, 14 (52%) were not aware of the AAA. Five patients with an AAA with a maximum diameter between 55 and 68 mm decided to postpone the operation. The remaining eight patients had an AAA with an initial maximum transverse diameter ranging from 32 to 54 mm (mean, 43 mm) and postponed their ultrasound follow-up visit during the pandemic. During the outbreaks of coronavirus disease 2019, a significant number of patients with rAAA might not have reached the hospital.2Natarajan J.P. Mahenthiran A.K. Bertges D.J. Huffman K.M. Eldrup-Jorgensen J. Lemmon G.W. Effects of coronavirus disease 2019 on the Society for Vascular Surgery Vascular Quality Initiative arterial procedure registry.J Vasc Surg. 2021; 73: 1852-1857Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar,3Johnston L.E. Robinson W.P. Tracci M.C. Kern J.A. Cherry K.J. Kron I.L. et al.Vascular Quality Initiative and National Surgical Quality Improvement Program registries capture different populations and outcomes in open infrainguinal bypass.J Vasc Surg. 2016; 64: 629-637Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar It is possible that the similarity between the ratio of elective and nonelective procedures before and during the pandemic reported by Sullivan et al may be misleading because a significant number of patients with rAAA did not reach the hospital. Our experience supports the importance to follow standard guidelines as concern surgery for AAA.4Bozzani A. Arici V. Ticozzelli G. Franciscone M.M. Sterpetti A.V. Ragni F. Increased rates of ruptured abdominal aortic aneurysm during the COVID-19 pandemic.J Vasc Surg. 2021; 74: 2119-2120Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 5Chaikof E.L. Dalman R.L. Eskandari M.K. Jackson B.M. Lee W.A. Mansour M.A. et al.The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.J Vasc Surg. 2018; 67: 2-77.e2Abstract Full Text Full Text PDF PubMed Scopus (1310) Google Scholar, 6Bozzani A. Arici V. Franciscone M. Ticozzelli G. Sterpetti A.V. Ragni F. COVID-19 patients with abdominal aortic aneurysm may be at higher risk for sudden enlargement and rupture.J Vasc Surg. 2022; 75: 387-388Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar Preliminary analysis of coronavirus disease 2019 variable insertion into Vascular Quality Initiative registriesJournal of Vascular SurgeryVol. 76Issue 5PreviewThe Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) reported a dramatic reduction in vascular registry activity at the start of the coronavirus 2019 (COVID-19) pandemic following the President’s order for a national lockdown in March 2020.1,2 Although the pandemic’s effect was global, variations in registry activity were noted between the VQI and Vascunet (a collaboration of international vascular registries administered by the European Society for Vascular Surgery) registries, with some countries maintaining a more normal workload during the first half of 2020. Full-Text PDF ReplyJournal of Vascular SurgeryVol. 77Issue 1PreviewWe thank Sterpetti et al for their comments on ruptured aneurysm frequency in Rome, Italy, during the coronavirus disease 2019 (COVID-19) pandemic.1 We acknowledge that the elective versus nonelective ratio is a marginal proxy at best for historical caseload comparisons.2 This is particularly true in aneurysmal disease, where we combined symptomatic and ruptured aneurysm patients for purpose of COVID-19 test analysis. Full-Text PDF