American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

COVID-19 Guidelines for Triage of Vascular Surgery Patients

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Category

Condition

Tier Class

AAA

Ruptured or symptomatic TAAA or AAA

3 Do not postpone

Aneurysm associated w/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 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 without overt sepsis, or hemorrhagic shock, or impending rupture

3 Do not postpone

Revascularization for high grade re-stenosis 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

AV fistula and graft placement for dialysis (ESRD, CK4, and CK5 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: Progressive tissue loss, acute limb ischemia, wet gangrene, ascending cellulitis

3 Do not postpone

Fasciotomy for compartment syndrome

3 Do not postpone

Peripheral Vascular Disease: Chronic limb threatening ischemia - 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

Thoracic Outlet Syndrome, Arterial with thrombosis

2b Postpone if possible

Thoracic Outlet Syndrome, Neurogenic

1 postpone

Thoracic Outlet Syndrome, 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 Ulcerations secondary to venous disease

2a Consider postponing

Asymptomatic May Thurner syndrome

1 Postpone

IVC filter removal

1 Postpone

Varicose veins, GSV ablations

1 Postpone

 

 

 

Wounds/ Gangrene/Amputation

Amputations for infection/necrosis (TMA, BKA, AKA)

3 Do not postpone

Lower extremity disease with non-salvageable 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

Amputations for infection/necrosis (toes)

2b Postpone if possible

 

 

 

Spine

ALIF exposure for Spine team

2a Consider postponing

 

 

 

Other

Surgery/Embolization for uncontrolled bleeding in unstable patients

3 Do not postpone

Surgery/Embolization for bleeding in stable patients

2b Postpone if possible

MediPort for immediate infusion needs

2b Postpone if possible

Port Removal for complication

2b Postpone if possible

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