Examining arguments and seeking solutions.
Moderator Alan B. Lumsden, MD (Houston Methodist),
Panelists Michael Lichtenberg, MD, FESC (Chefarzt Klinik fur Angiologie) Peter A. Schneider, MD (UCSF) John Rundback, MD (Holy Name Medical Center) Palma Shaw, MD (Upstate University Hospital), and Andrew Klein, MD (Piedmont Healthcare)
[Alan Lumsden] Introduction of Purpose, "Examine the arguments, seek solutions."
[Palma Shaw] Review of the American College of Surgeons Guidelines to assist in triage of patient procedures; introduction of panelists
Discussion on differences in the impact of these guidelines depending upon practice location and prevalence of covid-19; note contrast in infection control between US and Germany.
How to follow the patients when they cannot come to the hospital? How can we prevent a semi-urgent case from turning into an emergency?
The panel weighs in on what they are doing to connect with their patients: implementation is complicated and dependent on patient access to and familiarity with audiovisual technology.
Discussion regarding the use of testing in the reintroduction of procedures
[P. Schneider] Differences in response across panelist locations?
Reintroduction of patients in Germany vs. US
POLL: I am currently doing procedures for CLTI only (100%) claudication only (0%) CLTI and claudication (0%)
POLL: The pandemic has changed the type of procedures I would offer to a patient with critical limb ischemia.
RESULT: 81% True, 19% False
POLL: I have changed the location of where I practice critical limb interventions.
RESULT: 33% True, 67% False
POLL: I expect to return to at least 50% of my pre-pandemic practice within 2-4 weeks (7%) 4-8 weeks (50%) 8-12 (29%) >12 (14%)
POLL: My use of duplex ultrasound testing is same as precovid (20%) very selective (60%) emergent/urgent only (20%)
POLL If you opt to follow-up with a patient with CLI, how do you provide ongoing evaluation? Office visits (41%) Facetime at home (18%) Through my EMR telemedicine application (35%) Tell patient to contact me if it gets worse (6%)
Covid-Related Vascular Issues: Hypercoagulability
VTE Management discussion.
Thrombotic events and management, prevention
1:02:37-1:07:20 [A. Lumsden] Case scenarios
Consensus: The strategy now is different from our usual routine . Talk to the patients, reassure them, educate them
Discussion regarding re-initiating procedures and getting people to be willing to come into the hospital
[A. Lumsden] Why was the USA west coast affected differently?
Consensus: We will come out of this smarter. TEAM spirit has been remarkable, turf wars subside, decision-making expedites