Long-term results of open surgical methods for treating acute arterial thrombosis of peripheral arteries with and without advanced stage of covid-19 infection

Introduction. The pandemic of coronavirus infection has changed the course of diseases familiar to clinical practice. Vascular pathologies are a separate problem, since coronavirus infection affects coagulation processes and the immune response. Against the background of SARS-CoV-2 infection, the likelihood of specific complications increases, so a thorough assessment of treatment results and monitoring of the patency of reconstructed vessels is required. Hypercoagulation promotes the formation of blood clots, which can lead to repeated episodes of ischemia or thrombosis. In addition, inflammatory reactions characteristic of COVID-19 infection may increase the risk of complications after surgery. The purpose of this study was to compare the long-term results of open surgical interventions for DEC in patients with and without the acute stage of the new coronavirus infection COVID-19.
Materials and methods. The study included 136 patients with OIC who underwent open surgical revascularization. All patients were divided into two groups. Fifty patients without a history of coronavirus infection made up the first group (control). Group II (studies) included eighty-six patients who developed peripheral arterial thrombosis in the acute stage of COVID-19 infection. The patients' condition was assessed 6 and 12 months after surgical treatment according to ultrasound and MSCT angiography. The statistical analysis of the research materials was performed in the graphical analysis and development software environment "R" of the ComprehensIe R ArchIe Network, CRAN system.
Results. 77% of the treated patients were regularly monitored during the year. Patency of the operated arterial basin was comparable in the compared groups both 6 months and one year after surgery. Peripheral arterial retrombosis in the long-term postoperative period was 38.8% (7 patients) in the COVID-19 group and 42.8% (12 patients) in the control group (p<0.066). More often, repeated surgical interventions were performed in group II patients with a history of coronavirus infection.
Conclusion. The data obtained indicate that, despite significant differences in the immediate results of DEC treatment with open surgical revascularization in groups of patients with and without coronavirus infection, the frequency of retrombosis in the long-term postoperative period of the compared groups of patients is comparable.

1. Interim guidelines Prevention, diagnosis and course of a new coronavirus infection (COVID-19) Version 18 (10.26.2023). (In Russ.)

2. Zyuzin D.E., Tokarev P.A., Teplyakov D.V. Determination of predictors of unfavorable outcome in patients with acute limb ischemia in a new coronavirus infection in the acute phase of the disease. International Journal of Interventional Cardioangiology, 2023, № 73 (2), pp. 46–58. (In Russ.)

3. Nikolsky A.V., Kravchuk V.N., Trofimov N.A., Mukhin A.S., Volkov D.V., Nikolsky V.O., Zhidkov I.M., Bazhenova K.I. Remote results of various revascularization methods for acute limb ischemia in patients with COVID-19. Moscow Surgical Journal, 2024, № 3, pp. 73– 82. (In Russ.)

4. Etkin Y., Conway A.M., Silpe J. et al. Acute Arterial Thromboembolism in Patients with COVID-19 in the New York City Area. Ann. Vasc. Surg., 2021, № 70, pp. 290–294.

5. Bokeria L.A., Pokrovsky A.V. National guidelines for the diagnosis and treatment of lower extremity arterial diseases. Moscow, 2019. (In Russ.)

6. Vinokurov I.A. Acute lower extremity ischemia in the context of the COVID-19 pandemic. Cardiovascular Therapy and Prevention, 2021, № 20 (4), pp. 29–32. (In Russ.)

7. Han H., Yang L., Liu R., Liu F., Wu K., Li J., Liu X., Zhu C. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clinical Chemistry and Laboratory Medicine (CCLM), 2020, № 58 (7), рр. 1116–1120.

8. Zadumina D.N., Skvortsov V.V. Changes in hematological parameters during covid-19. LV, 2022, № 11. (In Russ.)

9. Asakura, H., Ogawa, H. COVID-19-associated coagulopathy and disseminated intravascular coagulation. Int J Hematol., 2021, № 113, рр. 45–57.

10. Bozzani A., Arici V., Tavazzi G,.et al. Acute Thrombosis of Lower Limbs Arteries in the Acute Phase and After Recovery From COVID-19. Ann Surg., 2021, № 273(4), рр. e159–e160. http://doi.org/10.1097/SLA.0000000000004700

11. Nikolsky A.V., Volkov D.V., Fedorovtsev V.A., Kosonogov A.Ya., Trofimov N.A., Kosonogov K.A., Penknovich A.A., Desyatnikova I.B., Garkavtsev A.V., Rybinsky A.D., Yarygin V.V., Gusev S.V., Trukhin K.V. Treatment of acute arterial thrombosis in patients with severe course of new coronavirus infection. Cardiology and cardiovascular surgery, 2022, № 15 (1), рр. 13–18. (In Russ.)

12. Al-Zoubi N., Shatnawi N., Jarbo H., Khader Y., Alzoubi H. Acute Limb Ischemia in Patients Infected with SARS-CoV-2. Vasc Endovascular Surg, 2022, № 56, pp. 90–95.

13. Gąsecka A., Borovac J.A., Guerreiro R.A., Giustozzi M., Parker W., Caldeira D., Chiva-Blanch G. Thrombotic Complications in Patients with COVID-19: Pathophysiological Mechanisms, Diagnosis, and Treatment. Cardiovasc Drugs Ther, 2021, №35, pp. 215–229.

14. Goldman I.A., Ye K., Scheinfeld M.H. Lower-extremity Arterial Thrombosis Associated with COVID-19 Is Characterized by Greater Thrombus Burden and Increased Rate of Amputation and Death. Radiology, 2020, № 297, pp. E263–E269.