key: cord-0816278-jpskiz6s
authors: Bozzani, Antonio; Arici, Vittorio; Ticozzelli, Giulia; Tavazzi, Guido; Sterpetti, Antonio V.; Mojoli, Francesco; Bruno, Raffaele; Ragni, Franco
title: Endovascular Surgery during COVID 19 virus pandemic as a valid alternative to open surgery.
date: 2020-11-03
journal: Ann Vasc Surg
DOI: 10.1016/j.avsg.2020.09.043
sha: 0023ccd185fa367f0118c3df73d9f13f94a6f4bc
doc_id: 816278
cord_uid: jpskiz6s

nan

positive cases documented in Italy, 30,000 were health workers. This data should be analyzed taking into consideration that most of the health workers were tested, whereas only 15% of the general population was tested (1, 2) .

In this scenario, many generally accepted evidence-based indications to surgery should be reevaluated taking in mind several specific matters, like as the prevention of contamination for patients and health workers. During the lock down period elective, deferrable surgeries have been rarely performed. There is a general attitude to prefer therapeutic schema which imply a reduced risk for complications and/or the risk for hospital admission. In patients with major, life-threatening complications requiring surgical intervention, a careful assessment of risk and benefits is always required; but in the pandemic period the possibility of contamination should be added to the usual considerations (3, 4) . In almost all hospitals, visits from relatives are not allowed, so that the patient undergoing major surgery should expect a significant isolation time with inevitable negative psychological consequences. Endovascular surgery can be performed under loco-regional J o u r n a l P r e -p r o o f anesthesia, avoiding general anesthesia with endo-tracheal intubation, reduced postoperative pain, and Intensive Care Unit permanence. The possibility of pulmonary complications, which may predispose and to aggravate COVID19 contamination and clinical course is reduced. Hospital stay is shorter. Endovascular procedures which have the same results of standard surgery, or even a marginal less effective result, are preferred. The possibility to defer the standard, more effective surgical operation at later times, after having resolved the emergency situation by a less risky endovascular procedure, is a reasonable clinical perspective (5) .

During the acute phase of the outbreak we have preferred to perform endovascular procedures whenever possible. Table 1 shows the arterial procedures performed during the acute phase of the out-break (in free or positive COVID19 patients) and during the same period of the previous year.

During the acute phase of the outbreak 10 COVID19 patients had arterial surgery.

Since the end of May there has been a steady and significant decrease in contamination and mortality rates in Italy and in Pavia. Now days, less than 5 COVID 19 deaths per day are reported in 

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