Discussion
The surgical management of vascular complications of COVID-19 patients
is challenging regarding the critical condition of many COVID-19
patients and the high-risk of aerosolization and related healthcare
provider contamination. Two original findings are reported in this
technical paper.
First, the occurrence of head and neck vascular complications in ICU
patients, which were poorly referenced in the literature. SARS-CoV-2 is
known to be associated with endothelial inflammation that weakens the
vascular wall.1 In our first reported case, it seems
conceivable that the tracheotomy tube could have weaken the
cricoarytenoid artery through a friction mechanism. This kind of
post-tracheotomy complication was however poorly reported in the
literature,3 strengthening the need to monitor
patients with severe COVID-19 after the realization of surgical
tracheotomy. In the second cases, the vascular lesion was relatively far
from the anatomical site of tracheotomies that were performed in front
of the third tracheal ring. Thus, we believe that the hemorrhage of the
second patient was not associated with the tracheotomy procedure, but it
was probably enhanced by the COVID-19 endothelial weaken, the patient
comorbidities and the use of preventive anticoagulation therapy.
Second, the rational to perform conservative treatment in COVID-19
patients was based on the critical condition of patients, the high risk
of aerosolization2,4 and the related risk of
healthcare provider contamination, especially
otolaryngologists.5 In this paper, we report two
original interventional radiological approaches for the treatment of
vascular lesions of the head and neck region. To the best of our
knowledge, there is no similar paper in the literature reporting such
percutaneous and endovascular approaches in the COVID-19 context. On the
one hand, these approaches avoid the risk of aerosolization during the
surgery revision where otolaryngologists mobilize the tracheotomy tube.
On the other hand, general anesthesia is not required that may be
valuable for patients who have comorbidities and critical clinical
condition. Notwithstanding the COVID-19 situation, interventional
radiological management of bleeding from superior or inferior thyroid
arteries was rarely reported3 despite safety, fast
realization and adequate post-intervention outcomes of these
approaches.6