1Medical Officer, General Surgery, Sultan Qaboos University Hospital, Oman
2Consultant Anesthesia, Sultan Qaboos University Hospital, Oman
3Senior consultant, Vascular surgery unit, Division of Surgery, Sultan Qaboos University Hospital, Oman
4Specialist, Vascular surgery unit, Division of Surgery, Sultan Qaboos University Hospital, Oman
5Clinical Nurse Specialist, Vascular surgery unit, Division of Surgery, Sultan Qaboos University Hospital, Oman
Background: The COVID-19 pandemic in its second wave brought along an increase in acute limb ischemia internationally. We noticed an increase in the presentation of geriatric critical limb ischemia during the pandemic, at our center. Therefore, we analyzed this observation to ascertain reasons for this observation and the outcome of management.
Methods: Our retrospective, observational study identified patients sixty years old and above with critical limb ischemia from March 2020 to July 2021 at our tertiary care hospital in Muscat, Oman, during the COVID pandemic. Electronic medical records of the patients were accessed, and data collected to include - patient demographics, comorbidities, inflammatory markers, drug history, management, and a follow up period of 3 months. Ethics approval was granted by the university ethics board for the study and patient permission given for use of images and clinical information.
Results: There were 13 patients in our study, six patients with Rutherford grade 5, two grade 6 and the rest were lesser than that, with an average age of 72.8 years (64-96 years); nine (69.2%) were males. Of the 13 patients two (15.4%) were COVID-19 positive, two had no comorbidities (15.4%) and eleven had at least 3 comorbidities (84.6%).
Ten patients underwent a CT angiogram; six (60%) had diseased femoropopliteal segment (TASC C, D). Eight were managed with endovascular intervention (80%); three were successfully re-vascularized and two underwent AKA, one BKA and two toe amputations. Two were unfit for imaging due to flexion deformities; one had non-constructible disease and were managed medically. There was no mortality during the study period.
Conclusion: We noticed a significant increase in the presentation of cases with CLI in the geriatric age group during the COVID pandemic at our center. This observation can be attributed to – CLI exacerbated due to subclinical COVID infection, more direct referral of lower grade of CLI patients considering that the secondary hospitals during the pandemic were unable to accommodate them, international travel ban/restrictions and restricted medical tourism. Travel restrictions within the country combined with patient/relative fear of contracting the COVID infection during hospital visits were other factors. A reduction in referrals was seen once tele-consultation facilities came into place.
Geriatric; CLI; CLTI; COVID-19; Pandemic; Oman; Referrals; Middle east; Ischemia; Critical
Edwin Stephen. Geriatric Critical Limb Ischemia during the Pandemic COVID-19, A Tertiary Center Experience from Oman. Int Case Rep Jour. 2022;2(5):1-6.