Vascular surgeons from across the USA are reporting health impacts on some patients, particularly elderly ones, in quarantine. The Society for Vascular Surgery (SVS) queried vascular surgeons regarding their concerns for patients’ health during the pandemic, and shared the findings as well as suggested solutions for patients with vascular disease who are confined at home.
Lack of activity is a key concern, vascular surgeons say, especially for seniors and patients who have chronic leg swelling. Vascular thrombosis (arterial and venous clotting) is being identified as a problem with COVID patients. While quarantine orders can restrict movement, there are ways to integrate activity into everyday life. Surgeons and doctors recommend people exercise as part of their daily routine, which can include walking outdoors. Getting up and moving every hour indoors is encouraged to help with circulation and maintaining muscle tone. When sitting for long periods of time, people can elevate their legs to help reduce swelling.
“Even marching in place and stepping side to side can aid in blood flow and helping someone feel more energised,” said Peter Mackrell, vascular surgeon, Vascular Surgery Associates and chief of Vascular Surgery, Sinai Hospital, Baltimore, USA. “Set an alarm to remind you to move or find a fitness app that provides movement reminders and step-by-step recommendations for simple at-home movement. Gyms and fitness experts have taken to the internet to offer live or on-demand exercise classes, from beginner to advanced fitness levels, to allow people to exercise from home.”
Another issue is an increase in stress levels. Stress is a risk factor for atherosclerosis, or hardening of the artery walls, making stress management education an important focus for in-care delivery. The SVS recommends making time to relax, practicing mindful breathing and connecting with others, as reported earlier this year, to make a positive difference in your body and overall mental health.
Another concern among specialists includes being able to determine which patients have what are deemed “medically-necessary” issues that would prompt surgery, rather than elective issues.
“While there are no evidence-based clinical practice guidelines, so to speak, there is a dedicated collaboration amongst specialists, sharing experiences and practices contributing to the care of vascular patients,” noted Nancy Crowell, a vascular nurse clinician in St Paul, USA. “The SVS has developed a continuously updated repository of COVID-19 resources for healthcare experts, including guidance in triaging vascular surgery patients’ procedures during the pandemic.”
Venous disease patients also concern vascular surgeons. Alan M Dietzek, network chief of vascular and endovascular surgery at the Western Connecticut Health Network, notes venous problems will likely be addressed in the near future as elective procedures are permitted to resume. He recommends patients with venous disease be informed that, in general, varicose veins, swelling and mild skin changes pose little immediate risk to their general health.
“Patients who have had abdominal aortic aneurysm surgery delayed while the COVID crisis recedes are understandably concerned about the risk of aneurysm rupture while they wait. They should take comfort in the knowledge that their vascular surgeon has very carefully weighed all the risks and benefits of this decision and have only delayed those patients in whom the risk of rupture in the short term is very low and therefore, waiting poses little risk to their health and well-being,” Dietzek said.
The SVS has collected a number of resources to provide information on COVID-19 and its impact and to provide the best care for vascular patients. Visit www.vsweb.org/C19Resources. Follow the SVS on Facebook @VascularHealth, Twitter @VascularSVS and Instagram @societyforvascularsurgery.