key: cord-0977407-uaubbz4r
authors: Ben Abdallah, Iannis; Coscas, Raphaël; Javerliat, Isabelle; Goëau-Brissonière, Olivier; Coggia, Marc; Pellenc, Quentin; Cerceau, Pierre; Castier, Yves; El Batti, Salma; Alsac, Jean-Marc; Julia, Pierre; Touma, Joseph; Cochennec, Frédéric; Desgranges, Pascal; Davaine, Jean-Michel; Gaudric, Julien; Chiche, Laurent; Koskas, Fabien
title: Early Experience in Paris with the Impact of the Covid-19 Pandemic on Vascular Surgery
date: 2020-04-23
journal: J Vasc Surg
DOI: 10.1016/j.jvs.2020.04.467
sha: 07c28cfad73a2238fdbf04e0cddbf50235b001a3
doc_id: 977407
cord_uid: uaubbz4r

nan

April 6th, 2020. Day 20 since the general lockdown in France. Paris area is the heart of the 22

Covid-19 pandemic in our country. Five years after the Paris terrorist attack in 2015, the Parisian 23 health care system is again facing an unprecedented challenge. But this time we are urging for 1 intensive care unit (ICU) beds, ventilators and personal protective equipment rather than 2 operating rooms (OR). Our ICU capacities have been doubled by transforming any available 3 space with ventilators into ICUs: recovery rooms, outpatient surgical unit, even ORs. As to spare 4 most of in-hospital resources, all non-emergent surgical procedures have been cancelled. ORs are 5 used to manage emergencies only. According to the French Society for Vascular Surgery's 6 recommendations based on the 3Ss principle (save Staff, Space and Stuff), our surgical activity is 7 now limited to the following emergencies: acute aortic syndromes, critical and acute limb 8 ischemia, symptomatic carotid stenosis, mesenteric ischemia and vascular access for 9 hemodialysis, with endovascular favored over open repair whenever possible to shorten hospital 10 and ICU stay. Regarding staff management, our daily rotations have been completely modified with one team 4 dedicated to vascular emergencies in each center. Remaining team members participate to 5

Covid-19 related activities in acute Covid-19 units and ensure telemedicine outpatient follow-up. 6

In ICU, we flip patients ventilated in the prone position and perform central line placement. For 7 vascular outpatient clinics, phone interviews have replaced classical clinics. 8 Surprisingly, we have observed a very significant decrease in overall vascular referrals as it has 9 been observed for stroke and myocardial infarction. This might be a collateral damage of the 10 pandemic that dissuades our fragile patients from consulting emergency departments. We will 11

probably face a post-pandemic wave of patients with severe vascular conditions. 12

To conclude, we would like to warn the vascular community about acute arterial 13 thromboembolic events that might be related to Covid-19 disease. 14

Antiphospholipid Antibodies in Patients with Covid-19

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