An Evaluation of Patients Admitted With Coronavirus Disease 19 Requiring Upper Extremity Vascular Revascularization

Coronavirus disease 19 (COVID-19) has been associated with significant acute thrombotic events; however, the outcomes for upper extremity (UE) intervention and best practices for limb-threatening ischemia in this population are limited. This study evaluated the outcomes of patients admitted with COVID-19 requiring an upper extremity intervention. Retrospective cohort study of COVID-19 patients using the Cerner Real-World Database (2019-2021). The database was queried for COVID-19 patients, then stratified by severity of COVID-19 into three groups: COVID (n = 1,343,639), COVID pneumonia (n = 425,491), and severe COVID requiring mechanical ventilation (n = 126,316). We use t tests, χ2 tests, and multivariate regression were used for statistical analysis. Among the 1,895,446 COVID-19 patients, 4380 UE procedures were performed: open bypass, 71%; endovascular intervention (ENDO), 11%; open embolectomy (EMBO), 9%; and primary amputation (PrAMP), 9%. Female sex, congestive heart failure, and peripheral vascular disease were associated with receiving ENDO (P < .0001). Patients with severe COVID requiring mechanical ventilation were most likely to receive PrAMP (26% vs bypass, 11.8%; ENDO, 18%; EMBO, 15%; P < .0001). Overall mortality after upper extremity intervention with COVID-19 was 10.1% (8% PrAMP; Bypass 9.7%; ENDO 12%; EMBO 13%; P = .03) and any amputation after attempted UE salvage was: bypass, 0.3%; ENDO, 0.01%; and EMBO 2% (P = NS). Multivariate regression demonstrated that patients peripheral vascular disease, congestive heart failure, and advanced age were associated with mortality (P = .0003). No single intervention was found to be superior for UE salvage. Primary amputation was associated with the lowest mortality rate, despite increased COVID-19 severity. Gender disparities were noted regarding procedure selection and even a simple embolectomy was associated with a 13% mortality in this unique population. Primary amputation must be considered as a viable first line intervention for patients with COVID-19 and further analysis of disparities and procedure selection are warranted.