Background. To share the results of a web-based expert panel discussion focusing on the management of acute and chronic aortic disease during the COVID-19 pandemic. Methods. A web-based expert panel discussion on April 18th 2020 where 8 experts were invited to share their current experience with COVID-19 disease touching several aspects of aortic medicine, was performed. After each talk, specific questions were asked to the online audience and results were immediately evaluated and shared with faculty and participants. Results. As of April 18 2020, 73.3% of the 87 participants from 26 different countries answered that overall less than 200 COVID positive patients have been treated in their respective institutions. Sixty-five percent reported that their hospital was well prepared for the pandemic. In 57.7 %, the percentage of infected health care professionals was below 5% whereas 23% reported 5-10% and 19.2% reported between 10 and 20%. Three percent reported to have seen aortic ruptures in primarily elective patients having been postponed because of the anticipated need to provide sufficient ICU capacity because of the pandemic. Nearly 70% reported a decrease of acute aortic syndromes since the start of the pandemic. Conclusions. The current COVID-19 pandemic has- led to a decrease of referrals of acute aortic syndromes in many services. The reluctance of patients seeking medical advice seems to be a major driver. The number of patients who have been postponed due to provisioning ICU resources but having experienced aortic rupture in the waiting period, is still low.

During the first phase of COVID-19 pandemic in Italy, several strategies have been taken to deal with the pandemic outbreak. The Regional Authority of Lombardy remodeled the hospitalization system in order to allocate appropriate resources to treat COVID-19 patients and to identify “Hub/Spoke” hospitals for highly specialized medical activities. The Hubs hospitals were required to guarantee full time evaluation of all patients presenting with cardiovavascular diseases with an independent pathway for patients with suspect or confirmed COVID-19 infection. San Raffaele Hospital was identified as Hub for cardiovascular emergencies and the Vascular Surgery Department was remodeled to face this epidemic situation. Surgical treatment was reserved only to symptomatic, urgent or emergent cases. Large areas of the hospital were simultaneously reorganized to assist COVID-19 patients. During this period, 135 patients were referred to San Raffaele Vascular Surgery Department. COVID-19 was diagnosed in 24 patients and, among them, acute limb ischemia was the most common cause of admission. At this time, the COVID-19 trend is in decline in Italy and the local authorities reorganized the health care system in order to return to normal activities avoiding new escalations of COVID-19 cases. Several strategies have been taken to ensure the safety of the San Raffaele hospital, and maintaining potentially suspected patients with COVID-19 separated from other patients. The aim of this paper is to report the remodeling of the Vascular Surgery Department of San Raffaele Hospital as regards the strategies of preparation, escalation, de-escalation and return to normal activities during the COVID-19 pandemic.