Objective: The first COVID-19 pandemic wave was a period of reduced surgical activity and redistribution of
resources to only those with late stage or critical presentations. This Vascular and Endovascular Research
Network COVID-19 Vascular Service (COVER) study aimed to describe the six-month outcomes of patients who
underwent open surgery and or endovascular interventions for major vascular conditions during this period.
Methods: In this international, multicentre, prospective, observational study, centres recruited consecutive
patients undergoing vascular procedures over a 12-week period. The study opened in March 2020 and closed to
recruitment in August 2020. Patient demographics, procedure details, and post-operative outcomes were
collected on a secure online database. The reported outcomes at 30 days and six months were post-operative
complications, re-interventions, and all cause in-hospital mortality rate. Multivariable logistic regression was used
to assess factors associated with six-month mortality rate.
Results: Data were collected on 3 150 vascular procedures, including 1 380 lower limb revascularisations, 609
amputations, 403 aortic, 289 carotid, and 469 other vascular interventions. The median age was 68 years
(interquartile range 59, 76), 73.5% were men, and 1.7% had confirmed COVID-19 disease. The cumulative all
cause in-hospital, 30-day, and six-month mortality rates were 9.1%, 10.4%, and 12.8%, respectively. The six-month
mortality rate was 32.1% (95% CI 24.2e40.8%) in patients with confirmed COVID-19 compared with 12.0% (95%
CI 10.8e13.2%) in those without. After adjustment, confirmed COVID-19 was associated with a three times
higher odds of six-month death (adjusted OR 3.25, 95% CI 2.18e4.83). Increasing ASA grade (3e5 vs. 1e2), frailty
scores 4e9, diabetes mellitus, and urgent and or immediate procedures were also independently associated with
increased odds of death by six months, while statin use had a protective effect.
Conclusion: During the first wave of the pandemic, the six-month mortality rate after vascular and endovascular
procedures was higher compared with historic pre-pandemic studies and associated with COVID-19 disease.