BIBA Briefings: Critical limb-threatening ischaemia interventions buck trend for emergency only procedures

Source: BIBA MedTech Insights

A BIBA MedTech Insights survey (conducted May 2020) indicates a trend towards centres only performing emergency percutaneous peripheral procedures during the COVID-19 pandemic. However, this trend is not seen with stenting/angioplasty for critical limb-threatening ischaemia. With critical limb ischaemia, the trend is for at least some elective procedures to still be performed.

BIBA MedTech Insights polled physicians at 238 centres across the globe about how the pandemic has affected clinical practice at their centre. More than half (55.8%) of respondents were vascular surgeons, with the rest of the respondents ranging from interventional radiologists to angiololgists. Furthermore, 46% of respondents came from the top four European countries: Italy, Germany, the UK, and Spain. Therefore, this article reviews the key Western European findings from the survey.

The survey showed that, in Western Europe, for both peripheral embolization and stenting/angioplasty for claudication, the majority of centres were only performing emergency procedures. For example, 69% of respondents reported that they were only performing emergency peripheral embolization and 61% said that they were only performing emergency stenting/angioplasty procedures for claudication. However, this tendency was not seen with critical limb ischaemia procedures. For stenting/angioplasty procedures for critical limb ischaemia, the majority of centres were performing at least some elective procedures: 40% for some procedures and 19% for all procedures versus 41% only performing emergency procedures. See Figure 1.

Source: BIBA MedTech Insights

Furthermore, of those still performing elective procedures for critical limb ischaemia, the tendency was for them to report seeing a reduction of 50% or less in elective procedures rather than a reduction of more than 50%. See Figure 2.

Source: BIBA MedTech Insights

The split between emergency only versus some versus all elective percutaneous procedures, for critical limb ischaemia, did vary depending on the country. For most countries, the majority of the centres were still performing at least some elective procedures. However, in the UK, 52% of centres reported performing emergency only procedures. In Spain, by contrast, only 29% of centres report performing emergency procedures (with 42% performing all procedures). See Figure 3

Source: BIBA MedTech Insights

Given that the survey suggests that elective critical limb ischaemia procedures have continued (albeit at a reduced level) during COVID-19, one may expect centres to “return to normal” relatively quickly once COVID-related restrictions have been lifted. Indeed, the survey does find that the majority of respondents in Western Europe estimate that their centre will go back to performing their usual level of elective critical limb ischaemia procedures within three months. Interestingly, although there is some variation, this trend is seen for all countries including the UK.

In terms of the measures needed to “clear the backlog” of elective procedures, overall, increased operating days, adjusted working practices (such as more frequently using a minimally invasive approach), and increased operating hours were the most common answers. However, of note, 10% felt no extra measures would be necessary.


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