Table I.
American College of Surgeons COVID-19 guidelines for triage of vascular surgery patients
| Category | Condition | Tier class |
|---|---|---|
| AAA | Ruptured or symptomatic TAAA or AAA | 3, Do not postpone |
| Aneurysm associated with infection or Prosthetic graft infection | 3, Do not postpone | |
| AAA > 6.5 cm | 2b, Postpone if possible | |
| TAAA > 6.5 cm | 2b, Postpone if possible | |
| AAA < 6.5 cm | 1, Postpone | |
| Aneurysm peripheral | Peripheral aneurysm, symptomatic | 3, Do not postpone |
| Peripheral aneurysm, asymptomatic | 2a, Consider postponing | |
| Pseudoaneurysm repair, not a candidate for thrombin injection or compression, rapidly expanding, complex | 3, Do not postpone | |
| Symptomatic non–aortic intra-abdominal aneurysm | 3, Do not postpone | |
| Asymptomatic non–aortic intra-abdominal aneurysm | 2a, Consider postponing | |
| Aortic dissection | Acute aortic dissection with rupture or malperfusion | 3, Do not postpone |
| Aortic emergency, NOS | AEF with septic/hemorrhagic shock, or signs of impending rupture | 3, Do not postpone |
| Bypass graft complications | Infected arterial prosthesis with overt sepsis, or hemorrhagic shock, or impending rupture | 3, Do not postpone |
| Revascularization for high-grade restenosis of previous intervention | 2b, Postpone if possible | |
| Asymptomatic bypass graft/stent restenosis | 1, Postpone | |
| Carotid | Symptomatic carotid stenosis: CEA and TCAR | 3, Do not postpone |
| Asymptomatic carotid artery stenosis | 1, Postpone | |
| Dialysis | Thrombosed or nonfunctional dialysis access | 3, Do not postpone |
| Infected dialysis access | 3, Do not postpone | |
| Fistula revision for ulceration | 3, Do not postpone | |
| Renal failure with need for dialysis access | 3, Do not postpone | |
| Tunneled dialysis catheter | 3, Do not postpone | |
| Fistula revision for malfunction/steal | 2b, Postpone if possible | |
| Fistulagram for malfunction | 2b, Postpone if possible | |
| AVF and AVG placement for dialysis (ESRD, CKD 4 and CKD 5 only) | 2a, Consider postponing | |
| Mesenteric | Symptomatic acute mesenteric occlusive disease | 3, Do not postpone |
| Chronic mesenteric ischemia | 2b, Postpone if possible | |
| PVD | Acute limb ischemia | 3, Do not postpone |
| Limb ischemia with progressive tissue loss, wet gangrene, ascending cellulitis | 3, Do not postpone | |
| Fasciotomy for compartment syndrome | 3, Do not postpone | |
| Chronic limb threatening ischemia with rest pain or tissue loss | 2b, Postpone if possible | |
| Peripheral angiograms and endovascular therapy for claudication | 1, Postpone | |
| Surgical procedures for claudication | 1, Postpone | |
| Thrombolysis | Lysis, arterial and venous | 2b, Postpone if possible |
| TOS | Symptomatic venous TOS with acute occlusion and marked swelling | 2b, Postpone if possible |
| Arterial TOS with thrombosis | 2b, Postpone if possible | |
| Neurogenic TOS | 1, Postpone | |
| TOS, venous otherwise | 2a, Consider postponing | |
| Trauma | Traumatic injury with hemorrhage and/or ischemia | 3, Do not postpone |
| Venous | Acute iliofemoral DVT with phlegmasia | 3, Do not postpone |
| IVC filter placement | 2b, Postpone if possible | |
| Massive symptomatic iliofemoral DVT in low risk patient | 2b, Postpone if possible | |
| Procedures for ulceration secondary to venous disease | 2a, Consider postponing | |
| Asymptomatic May-Thurner syndrome | 1, Postpone | |
| IVC filter removal | 1, Postpone | |
| Varicose veins, GSV ablation | 1, Postpone | |
| Wound; gangrene; amputation | Amputation for infection/necrosis (TMA, BKA, AKA) | 3, Do not postpone |
| Lower extremity disease with nonsalvageable limb (amputation) | 3, Do not postpone | |
| Deep debridement of surgical wound infection or necrosis | 2b, Postpone if possible | |
| Wounds requiring skin grafts | 2b, Postpone if possible | |
| Amputation for infection/necrosis (toes) | 2b, Postpone if possible | |
| Spine | ALIF exposure | 2a, Consider postponing |
| Other | Surgery/embolization for uncontrolled bleeding in unstable patient | 3, Do not postpone |
| Surgery/embolization for bleeding in stable patient | 2b, Postpone if possible | |
| MediPort for immediate infusion needs | 2b, Postpone if possible | |
| Port removal for complication | 2b, Postpone if possible |
AAA, Abdominal aortic aneurysm; AEF, aortoenteric fistula; AKA, above-the-knee amputation; ALIF, anterior lumbar interbody fistula; AVF, arteriovenous fistula; AVG, arteriovenous graft; BKA, below-the-knee amputation; CEA, carotid endarterectomy; CKD, chronic kidney disease (stage); DVT, deep vein thrombus; ESRD, end-stage renal disease; GSV, great saphenous vein; IVC, inferior vena cava; NOS, not otherwise specified; PVD, peripheral vascular disease; TAAA, thoracoabdominal aortic aneurysm; TCAR, transcarotid artery revascularization; TMA, transmetatarsal amputation; TOS, thoracic outlet syndrome.