COVID-19: The role of vascular surgeons—A New York centre perspective

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Thomas Maldonado and Michael Barfield, both of NYU Langone Health (New York, USA), share their experiences of the coronavirus outbreak and discuss how the skills of vascular surgeons can be best utilised during the COVID-19 pandemic.

Maldonado says it is a “very grim picture” and notes that of those COVID-19 patients put on a ventilator, roughly a third have died. There is however “some hope” that the curve is flattening, says Maldonado, highlighting that there has been a “significant drop” in ER COVID hospital admissions. Barfield outlines what types of cases he is being called on for as a vascular surgeon, which he says are “for the most part” those patients with thrombotic complications, particularly in the lower limbs.

The pair discuss how the crisis has impacted the workflow with Maldonado noting that now they are working with a “skeleton crew”. Barfield says that “one of the first things I noticed” on the ICUs was that the COVID-19 patients were “hypercoagulable”. The pair also discuss treatment options and the pathologies of patients they have experienced as well as some of the complications caused by “aggressive anticoagulation” including intracranial haemorrhages.

Barfield concludes that “one of the best thing we have been doing is starting the anticoagulation much earlier” and notes that the biggest lesson he has learnt is that “you have to be flexible and be willing to pick up and do whatever needs to be done”.

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