Outcomes of Acute Limb Ischemia at a Large Public Hospital in Brazil: insights before, during and after the COVID-19 pandemic.

Introduction: This study compared outcomes of patients with acute limb ischemia (ALI) before, during, and after the COVID-19 pandemic, hypothesizing that poor outcomes observed during the pandemic have not yet been resolved.

Methods: This retrospective, observational, single-center study analyzed ALI patients from 2019 to 2023.

Results: Over five years, 298 patients underwent surgery for ALI at our hospital: 35 had COVID-19 (COVID Group), 132 tested negative (Non-COVID Group), 71 were treated before the pandemic (Pre-COVID Group), and 60 after (Post-COVID Group). In 2020, 32% of ALI patients had COVID-19, a percentage that decreased over time. Baseline characteristics shifted, influencing treatment. The Pre-COVID Group had more cardiac disease with embolic ALI and required mainly embolectomy; the COVID Group had worse clinical conditions, undergoing embolectomy or amputation. The Post-COVID Group had more thrombotic ALI, with increased bypass surgery needs. Prolonged ischemia time was a concern during the entire study; 29% of patients presented with Rutherford III ischemia at admission, and 35.2% required major amputations. COVID Group had higher mortality (48.6% vs. 15.5% Pre-COVID, 22.7% Non-COVID, and 28.3% Post-COVID, P=0.003). Additional factors contributing to mortality included older age (OR 1.05 CI 1.02-1.08, P<0.001), prior stroke (OR 2.38, CI 1.07-5.38, P<0.001), COPD (OR 1.88, CI 0.53-6.59, P=0.03), and aorto-iliac ALI (OR 8.72, CI 1.25-22.63, P<0.01).

Conclusion: Delayed presentations of ALI patients persisted before, during, and after the pandemic, resulting in many cases of irreversible ischemia at admission and increased amputation rates. Mortality rates correlated with COVID-19, older age, COPD, prior stroke, and aorto-iliac involvement.