Amidst the continuing COVID-19 pandemic, concerns have mounted in the vascular community about the disruption to clinical routine. As vascular patients are particularly vulnerable to both COVID-19 and the effects of delayed surgical care, a need for collaboration, data, and practice changes has emerged. Robert Cuff (Spectrum Health, Grand Rapids, USA) and Max Wohlauer (University of Colorado School of Medicine, Aurora, USA) have responded, founding the Vascular Surgery COVID-19 Collaborative (VASCC).
In a research letter published online on 29 July in the European Journal of Vascular and Endovascular Surgery (EJVES), Mario D’Oria (Trieste University Hospital, Trieste, Italy) and colleagues, on behalf of VASCC, outline the project and urge their vascular colleagues to get involved.
They write that VASCC was established to provide vascular surgeons from around the world with the opportunity to study the fundamental issues facing the vascular specialty through two distinct research projects.
The first project focuses on the impact of COVID-19 on scheduled vascular operations. According to D’Oria et al, this element of the study “provides a mechanism to formally assess the impact of surgical delay on patients with vascular disease and will investigate the natural history of those whose operations were postponed as a result of the pandemic”. Covering five major areas of vascular practice and conditions—carotid, aortic, peripheral, venous, and haemodialysis—it will also evaluate alterations in surgical care provided in response to the pandemic, and changes in type and location of surgery performed.
VASCC also aims to address thrombotic complications of COVID-19. D’Oria and colleagues detail that this second project “seeks to investigate the possible thrombotic manifestations of the disease and to underline management practices under such circumstances”. They add that it will have four specific modules encompassing a wide range of thrombotic conditions of the arterial and venous systems: acute limb ischaemia, acute mesenteric ischaemia, symptomatic venous thromboembolism, and stroke.
D’Oria et al emphasise the unparalleled effects the ongoing COVID-19 pandemic has had on vascular surgery. “Not in our lifetime have we seen such a rapid and widespread cancellation of scheduled surgical operations,” they write, adding that nearly all hospitals in regions affected by the pandemic temporarily halted the performance of elective surgery at some point, and, for many of them, only emergency operations were being performed during the peak of the COVID-19 surge.
Broad participation required
In order to address the need for data and new protocols for vascular patients, D’Oria et al emphasise the need for global collaboration. “Worldwide coordinated efforts are needed to obtain high-quality data of sufficient power to overcome the limitations imposed by scattered gathering of information.”
They report that, as of 9 June, VASCC has received commitment from more than 200 collaborators encompassing 171 sites and 34 countries.
A potential limitation of the study, the authors of the research letter acknowledge, is that some areas of the world might have been able to continue elective surgery so far during the pandemic. However, they stress that these regions may be affected in the future. “Understanding the impact of the pandemic on the provision of vascular treatment could be useful to tailor better pathways of care,” they write.
“Obvious and urgent appetite” for research
In parallel to VASCC, the COVID-19 vascular service (COVER) trial is also capturing global data on vascular practice amidst the current pandemic.
D’Oria and colleagues see this as an example of an “obvious and urgent appetite” for research around the COVID-19 pandemic among physicians, institutions, and policymakers.
“We view these projects as complementary and encourage participation in both,” the authors of the VASCC research letter write.
With support from both the Vascular Society of Great Britain and Ireland (VSGBI) and the European Society for Vascular Surgery (ESVS), the COVER study is a multinational, prospective, observational study that is aimed at capturing the impact of the pandemic on global vascular surgery. An international Vascular and Endovascular Research Network (VERN) project, the COVER study was designed to assess the provision, practice, and outcomes of vascular surgery and its effect on patients during the COVID-19 pandemic.
Sandip Nandhra (Newcastle University, Newcastle, UK) and Ruth Benson (VERN president, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK) are co-leads of the study alongside the VERN executive, with Chris Imray (University Hospitals Coventry and Warwickshire NHS Trust), the president of the VSGBI, and Athanasios Saratzis (University of Leicester, Leicester, UK) as chief investigators.
In line with the goals of VASCC, the aim of COVER is to capture global data on vascular practice amidst the current pandemic in order to better understand its impact on vascular patients. In addition, they seek to provide the international vascular community with usable data to improve care pathways for vascular patients in the face of predictable resurgences of COVID-19, or in the case of a future pandemic or natural disaster.
“An opportunity”
D’Oria et al recognise that a great number of patients may have had their procedures postponed due to COVID-19, which mandates an analysis of the consequences of a delay to their treatment. The importance of research, and of the unique research opportunities this situation presents, “should not be overlooked, but considered an opportunity,” they state.
“Vascular surgeons are often at the frontline of the treatment of thrombotic diseases, putting them in a privileged position to explore the topic”.
