An increased severity of peripheral arterial disease in the COVID-19 era

The recent coronavirus 2019 (COVID-19) pandemic has significantly increased the pressure on our healthcare system around the world. The health emergency has changed the organization of health institutions and focused attention on pandemic management. This has led to important changes in the treatment of patients without COVID-19 and has resulted in the most difficult access to care with delays in diagnosis and treatment. Vascular diseases, including peripheral arterial disease, will require rapid treatment in most cases. The severity of peripheral arterial disease is assessed using a functional classification system (Fontaine or Rutherford). The most severe grades of classifications include critical limb ischemia (CLI). CLI is defined by limb pain at rest, nonhealing wounds or ulcers, and/or gangrene in one or both legs.¹ CLI requires rapid revascularization to avoid tissue loss and amputation. The introduction of the lockdown in Italy from March 9, 2020, led to the closure of outpatient activities and prevented early observation of patients with CLI. Furthermore, the fear of contagion led to an underestimation of the symptoms and delayed access to treatment through the emergency room. Thus, patients with severe CLI with significant septic ulcers and gangrene arrived at our vascular surgery department. For most of these patients, it was not possible to save the limbs, and, therefore, they underwent amputation surgery. We observed that the number of amputations performed in our department from March 9 to April 20, 2020, was significantly greater than the number performed in the same period in 2019. Specifically, we performed 9 amputations during this period compared with 5 amputations performed in 2019 in the same period; an increase of almost 50%. We believe that the COVID-19 pandemic has led to the poor treatment of patients with other pathologic entities; thus, it is necessary to adopt more suitable measures to avoid other serious consequences on the health of citizens. Consequently, it is necessary to identify paths that will allow these patients to have rapid access to treatment with marked improvements in outcome.