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

Background: 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 5 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), chronic obstructive pulmonary disease (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.