We thank Sterpetti et al for their comments on ruptured aneurysm frequency in Rome, Italy, during the coronavirus disease 2019 (COVID-19) pandemic.1 We acknowledge that the elective versus nonelective ratio is a marginal proxy at best for historical caseload comparisons.2 This is particularly true in aneurysmal disease, where we combined symptomatic and ruptured aneurysm patients for purpose of COVID-19 test analysis.
We have previously reported on geographic variation in pandemic procedure volumes identified in vascular registries (the Vascular Quality Initiative [VQI], United Kingdom-National Vascular Registry [UK-NVR], VASCUNET, Australasia).3 Emergency care for ruptured aneurysms remained fairly constant within registries during pandemic comparisons; however, we were unable to determine the number of patients who died outside of the hospital setting from an aneurysm that ruptured. That information is beyond the scope of the VQI (and most) registries. Single-center ruptured abdominal aortic aneurysm volumes as reported by Sterpetti et al may vary significantly from the statistical mean of a large database registry such as the VQI (pandemic aneurysm procedure volume n = 3951) when reported during the COVID-19 outbreak. Evaluation of significance must consider the standard deviation of outcomes and power level of analysis. Although seasonal variation of ruptured abdominal aortic aneurysm has been identified previously,4 our focus was outcome differences on COVID-19 testing and any procedure delay compared with historical controls. We await findings of the Vascular Surgery COVID-19 Collaborative to better define those patients succumbing to aneurysm rupture awaiting treatment.5
References
- 1.Sterpetti A.V., et al. The negative effects of reduced attention to standard guidelines for screening and surgery of abdominal aortic aneurysms during the coronavirus disease 2019 pandemic. J Vasc Surg. 2022 doi: 10.1016/j.jvs.2022.08.039. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Sullivan K., Mureebe L., Huffman K., Eldrup-Jorgensen J., Lemmon G.W. Preliminary analysis of coronavirus disease 2019 variable insertion into Vascular Quality Initiative registries. J Vasc Surg. 2022 doi: 10.1016/j.jvs.2022.06.009. Online ahead of print. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Aziz F., Behrendt C.A., Sullivan K., Beck A.W., Beiles C.B., Boyle J.R., et al. The impact of COVID-19 pandemic on vascular registries and clinical trials. Semin Vasc Surg. 2021;34:28–36. doi: 10.1053/j.semvascsurg.2021.04.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Sterpetti A.V., Cavallari N., Allegrucci P., Agosta R., Cavallaro A. Seasonal variation in the incidence of ruptured abdominal aortic aneurysm. J R Coll Surg Edinb. 1995;40:14–15. [PubMed] [Google Scholar]
- 5.Mouawad N.J., Cuff R.F., Hultgren R., Chuen J., Galeazzi E., Wohlauer M. The Vascular Surgery COVID-19 collaborative (VASCC) J Vasc Surg. 2020;72:379–380. doi: 10.1016/j.jvs.2020.04.463. [DOI] [PMC free article] [PubMed] [Google Scholar]