Acute limb ischemia in a cancer patient has high morbidity, high mortality, and atypical presentation: a tertiary cancer center’s retrospective study

Abstract Background Acute Limb Ischemia (ALI) carries a high morbidity and mortality rate that is compounded in the cancer patient. Though it is a relatively uncommon event, it is of extremely high adverse impact and carries poor awareness among clinicians. Methods Retrospective review of electronic medical records was performed of cancer patients presenting with acute limb ischemia (ALI) to the tertiary cancer center’s urgent care center or as inpatient between January 1, 2014 and January 1, 2020. Results Out of the 29 cancer patients with ALI, 12 (41%) died within 3 month and 9 (31%) patients died within 1 months of ALI diagnosis. 65% had long term adverse outcome after ALI – 31% with death in 1 month, 2 (7%) with an amputation, 5 (17%) with lifestyle-limiting claudication, and 3 (10%) with subsequent wound ulceration or gangrene. Patients not eligible for standard of care (12 patients, 41%) (RR 2.33 95% CI [1.27–4.27], p < 0.01) and heparin administration ≥6 h from presentation (19 patients, 65%) (RR 2.81 [1.07–7.38], p = 0.04) were at increased risk of adverse outcome. Atypical/confounded presentation of ALI (13 patients, 45%) (RR 1.84 95% CI [1.03–3.29], p = 0.04), pulse exam not documented (12 patients, 41.4%) (RR 1.95 [95% CI [1.14–3.32], p = 0.01), and patients with services other than a vascular specialist initially consulted (8 patients, 27.6%) (RR 1.91 95% CI [1.27–2.87], p < 0.01) were significant risk factors for heparin administered ≥6 h from presentation. Conclusions ALI is devastating in cancer patients, with a high number presenting with atypical/confounded signs and symptoms which delays treatment. Heparin administered ≥6 h from presentation is associated with adverse outcome.

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Acute Limb Ischemia in a Cancer Patient Has High Morbidity, High Mortality, and Atypical Presentation: A Tertiary Cancer Center’s Retrospective Study

10.21203/rs.3.rs-438538/v1 ◽

2021 ◽

Author(s):

Yolanda Bryce ◽

Emmanuel Jnr Amoateng ◽

Christopher Agrusa ◽

Etay Ziv ◽

Christopher Harnain ◽

...

Keyword(s):

Cancer Patient ◽

Cancer Patients ◽

Adverse Outcome ◽

Significant Risk ◽

Limb Ischemia ◽

Urgent Care ◽

High Morbidity ◽

Acute Limb Ischemia ◽

Heparin Administration ◽

Increased Risk

Abstract Background Acute Limb Ischemia (ALI) carries a high morbidity and mortality rate that is compounded in the cancer patient. Though it is a relatively uncommon event, it is of extremely high adverse impact and carries poor awareness among clinicians. Methods Cancer patients presenting with acute limb ischemia (ALI) to the tertiary cancer center’s urgent care center or as inpatient between January 1, 2014 and January 1, 2020 were reviewed. Results Out of the 29 cancer patients with ALI, 12 (41%) died within 3 month and 9 (31%) patients died within 1 months of ALI diagnosis. 65% had long term adverse outcome after ALI – 31% with death in 1 month, 2 (7%) with an amputation, 5 (17%) with lifestyle-limiting claudication, and 3 (10%) with subsequent wound ulceration or gangrene. Patients not eligible for standard of care (12 patients, 41%) (RR 2.3333 95% CI [1.2743–4.2724], p = 0.0022) and heparin administration ≥ 6 hours from presentation (19 patients, 65%) (RR 2.8070 [1.0677–7.3795], p = 0.0364) were at increased risk of adverse outcome. Atypical/confounded presentation of ALI (13 patients, 45%) (RR 1.8367 95% CI [1.0266–3.2862], p = 0.0405), pulse exam not documented (12 patients, 41.4%) (RR 1.9479 [95% CI [1.1439–3.3169], p = 0.0141), and patients with services other than a vascular specialist initially consulted (8 patients, 27.6%) (RR 1.9091 95% CI [1.2698–2.8703], p = 0.0019) were significant risk factors for heparin administered ≥ 6 hours from presentation. Conclusions ALI is devastating in cancer patients, with a high number presenting with atypical/confounded signs and symptoms which delays treatment. Heparin administered ≥ 6 hours from presentation is associated with adverse outcome.

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Predictive Value of D-Dimer Levels for Venous Thromboembolism in Cancer Patients: Results from the Vienna Cancer and Thrombosis Study (CATS)

Blood ◽

10.1182/blood.v112.11.3824.3824 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3824-3824

Author(s):

Cihan Ay ◽

Rainer Vormittag ◽

Daniela Dunkler ◽

Ralph Simanek ◽

Alexandru-Laurentiu Chiriac ◽

...

Keyword(s):

Venous Thromboembolism ◽

Cancer Patients ◽

Predictive Value ◽

Significant Risk ◽

Cumulative Probability ◽

Total Study Population ◽

Cox Regression Analysis ◽

Increased Risk ◽

Diagnosis Of Cancer ◽

D Dimer

Abstract Venous thromboembolism (VTE) is a frequent complication of cancer, which represents a major cause of morbidity and mortality in cancer patients. Laboratory parameters with a predictive value for VTE could help to assign a patient to a high or low risk group. D-Dimer is a global indicator of coagulation activation and fibrinolysis and is frequently elevated in cancer patients, even without thrombosis. The measurement of D-dimer levels is a widely applied test in the diagnostic work-up of patients with suspected VTE. Prospective observational studies have shown that D-dimer levels have a predictive value for the risk of recurrence in non-cancer patients after the discontinuation of oral anticoagulant treatment. Whether testing for D-Dimer at diagnosis of cancer would be useful for prediction of cancer-associated thrombosis, is not elucidated because up to now appropriately designed prospective studies have not yet been carried out. Therefore, we have assessed D-Dimer levels in cancer patients as risk predictor for VTE and provide a report from the ongoing prospective observational CATS, which was initiated in October 2003. Patients with newly diagnosed cancer or progression of disease that had neither chemotherapy within the last three months, nor radiotherapy nor surgery within the last two weeks were recruited and followed prospectively. Occurrence of VTE and information on the patients’ anti-cancer-treatment within the follow up period were recorded. Observation ended with occurrence of VTE, death or after 2 years. VTE has always been confirmed by imaging. D-Dimer levels were measured with a D-Dimer latex agglutination assay. Kaplan Meier and Cox regression analysis were applied for statistical calculation. Data on 821 patients with cancer (370 women/451 men, median age [IQR]: 62 [53–68] yrs) were available for analyses. Patients were followed for a median observation time of 454 days. Main tumour entities were malignancies of the breast (n=132), lung (n=119), upper (n=35) and lower gastrointestinal tract (n=106), pancreas (n=46), kidney (n=22) and prostate (n=101). Furthermore, 102 patients had high-grade glioma, 94 lymphomas, 17 multiple myeloma and 47 other tumour types. During the observation period VTE occurred in 62 patients (24 female/38 male, median age [IQR]: 60 [50–66] yrs). Elevated levels of D-Dimer (cut-off level 1.44 μg/ml, representing the 75th percentile of the total study population) [hazard ratio (HR): 2.4, 95% CI 1.4–4.0], surgery [HR: 2.3, 95% CI 1.0–5.3] and radiotherapy [HR: 2.3, 95% CI 1.2–4.4] were statistically significant risk factors for VTE in multivariate analysis including D-Dimer, age, sex, surgery, chemotherapy and radiotherapy. The cumulative probability of developing VTE after 6 months was 11.2 % in patients with D-Dimer levels above and 4.2 % in those below the 75th percentile (p=0.003). In conclusion, cancer patients with elevated D-Dimer levels have an approximately 3-fold increased risk for future occurrence of VTE. High levels of D-Dimer independently predict VTE in these patients and D-Dimer measurement at diagnosis of cancer would help identify patients at increased risk for VTE.

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Therapeutic Angiogenesis for Severely Ischemic Limbs — from Bench to Bedside in Acute Vascular Care

Journal Of Cardiovascular Emergencies ◽

10.1515/jce-2017-0028 ◽

2017 ◽

Vol 3 (4) ◽

pp. 160-171

Author(s):

Theodora Benedek ◽

István Kovács ◽

Imre Benedek

Keyword(s):

Surgical Treatment ◽

Limb Salvage ◽

Arterial Occlusion ◽

Limb Ischemia ◽

Therapeutic Angiogenesis ◽

Lower Limbs ◽

Current Status ◽

High Morbidity ◽

Acute Limb Ischemia ◽

Promising Alternative

Abstract Severe limb ischemia represents a critical condition, being associated with high morbidity and mortality rates. Patients with critical limb ischemia (CLI) require urgent initiation of interventional or surgical treatment, as restoration of the blood flow is the only way to ensure limb salvage in these critical cases. At the same time, in acute limb ischemia, a dramatic form of sudden arterial occlusion of the lower limbs, the integrity of the limb is also seriously threatened in the absence of urgent revascularization. From patients with CLI, 40% are “no option CLI”, meaning patients in whom, due to anatomical considerations or to the severity of the lesions, there is no possibility to perform interventional or surgical treatment or they have failed. Therapeutic angiogenesis has been proposed to serve as an effective and promising alternative therapy for patients with severe limb ischemia who do not have any other option for revascularization. This review aims to present the current status in therapeutic angiogenesis and the role of different approaches (gene or cell therapy, intra-arterial vs. intramuscular injections, different sources of cells) in increasing the rates of limb salvage in patients with severe ischemia of the lower limbs.

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Outcome in Patients with Acute Limb Ischemia Post Hybrid Procedure Compared to Surgical Thrombectomy

Journal of Indonesian Society for Vascular and Endovascular Surgery ◽

10.36864/jinasvs.2020.2.013 ◽

2020 ◽

Vol 1 (2) ◽

pp. 55-60

Author(s):

Nyityasmono Nugroho ◽

Nyityasmono Tri Nugroho ◽

Dedy Pratama

Keyword(s):

Critical Review ◽

Literature Search ◽

Limb Ischemia ◽

Hybrid Procedure ◽

P Value ◽

High Morbidity ◽

Acute Limb Ischemia ◽

Research Database ◽

Best Management ◽

Surgical Thrombectomy

Introduction: Acute limb ischemia (ALI) is characterized by decreased perfusion to extremities in the form of acute ischemia and the presence of acute thrombus which may endanger the viability of the extremities. Therapeutic modalities are various including intraarterial thrombolysis with or without the help of ultrasonography and the use of thrombectomy instruments. However, due to the high morbidity and mortality rate, a new technique called the hybrid procedure is introduced. This procedure is a combination between endovascular management to correct the abnormalities with the help of angiography as well as thrombectomy surgical management, in the same time. Therefore, it is necessary to conduct a literature search related to the case we are reporting, to determine whether hybrid procedure or thrombectomy only is the best management for ALI. This study aims to determine the best management for the case being reported according to literature search and critical reviews collected from medical research database. Method: From the data collected, there was one interesting case, which is a case about acute limb ischemia, and the following operative management. Afterwards, a literature search was conducted to obtain articles related to the case, and critical review was made regarding the selected article. Results: At the end of the literature search, we found two articles which showed better outcome on hybrid procedure compared to surgical thrombectomy. Compared to the group who underwent thrombectomy, there was decreased 30-days mortality in the group who underwent the hybrid procedure (3.3% vs 4.4%, p-value 0.05), decreased incidence of amputations after 30 days (6.49% vs 13.5%, p-value 0.023), increased limb salvage (91.9% vs 82.3%, p-value 0.03, 95% CI), and decreased two-years mortality (18.7% vs 40.5%; p– value <0.001). Conclusion: Critical review on articles obtained from literature search in online database showed that the outcome hybrid procedure was better than surgical thrombectomy only. Keywords: acute limb ischemia; hybrid procedure; thrombectomy; outcome

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Neutrophil-to-lymphocyte ratio associated with an increased risk of mortality in patients with critical limb ischemia

PLoS ONE ◽

10.1371/journal.pone.0252030 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0252030

Author(s):

Min-I. Su ◽

Cheng-Wei Liu

Keyword(s):

Hospital Mortality ◽

Critical Limb Ischemia ◽

Limb Ischemia ◽

Neutrophil To Lymphocyte Ratio ◽

Major Adverse Cardiovascular Events ◽

Acute Limb Ischemia ◽

Male Body ◽

Lymphocyte Ratio ◽

Increased Risk ◽

Related Mortality

Purpose Association of the neutrophil-to-lymphocyte ratio (NLR) with mortality has not been comprehensively explored in critical limb ischemia (CLI) patients. We investigated the association between the NLR and clinical outcomes in CLI. Materials and methods We retrospectively enrolled consecutive CLI patients between 1/1/2013 and 12/31/2018. Receiver operating characteristic curve analysis determined NLR cutoffs for 1-year in-hospital, all-cause and cardiac-related mortality; major adverse cardiovascular events (MACEs); and major adverse limb events (MALEs). Results Among 195 patients (age, 74.0 years, SD: 11.5; 51.8% male; body mass index, 23.4 kg/m2, SD: 4.2), 14.4% exhibited acute limb ischemia. After 1 year, patients with NLR>8 had higher in-hospital mortality (21.1% vs. 3.6%, P<0.001), all-cause mortality (54.4% vs. 13.8%, P<0.001), cardiac-related mortality (28.1% vs. 6.5%, P<0.001), MACE (29.8% vs. 13.0%, P = 0.008), and MALE (28.1% vs. 13.0%, P = 0.021) rates than those with NLR<8. In multivariate logistic regression, NLR≥8 was significantly associated with all-cause (P<0.001) and cardiac-related (adjusted HR: 5.286, 95% CI: 2.075–13.47, P<0.001) mortality, and NLR≥6 was significantly associated with MALEs (adjusted HR: 2.804, 95% CI: 1.292–6.088, P = 0.009). Each increase in the NLR was associated with increases in all-cause (adjusted HR: 1.028, 95% CI: 1.008–1.049, P = 0.007) and cardiac-related (adjusted HR:1.027, 95% CI: 0.998–1.057, P = 0.073) mortality but not in-hospital mortality or MACEs. Conclusion CLI patients with high NLRs had significantly higher risks of 1-year all-cause and cardiac-related mortality and MALEs. The NLR can be used for prognostic prediction in these patients.

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COVID-19 in Cancer Patients, Risk Factors for Disease and Adverse Outcome, a Population-Based Study From Norway

Frontiers in Oncology ◽

10.3389/fonc.2021.652535 ◽

2021 ◽

Vol 11 ◽

Author(s):

Tom Børge Johannesen ◽

Sigbjørn Smeland ◽

Stein Aaserud ◽

Eirik Alnes Buanes ◽

Anna Skog ◽

...

Keyword(s):

Intensive Care ◽

Cancer Patients ◽

Adverse Outcome ◽

Population Based ◽

Treatment Modalities ◽

Major Surgery ◽

Prescription Database ◽

Population Based Study ◽

The Past ◽

Increased Risk

BackgroundCancer has been suggested as a risk factor for severe outcome of SARS-CoV-2 infection. In this population-based study we aimed to identify factors associated with higher risk of COVID-19 and adverse outcome.MethodsData on all confirmed SARS-CoV-2 positive patients in the period January 1 to May 31, 2020 were extracted from the Norwegian Surveillance System for Communicable Diseases. Data on cancer and treatment was available from the Cancer Registry of Norway, the Norwegian Patient Registry and the Norwegian Prescription Database. Deaths due to COVID-19 were extracted from the Cause of Death Registry. From the Norwegian Intensive Care and Pandemic Registry we retrieved data on admittance to hospital and intensive care. We determined rates of COVID-19 disease in cancer patients and the rest of the population. We also ran multivariate analyses adjusting for age and gender.ResultsA total of 8 410 patients were diagnosed with SARS-CoV-2 infection in Norway during the study period, of which 547 (6.5%) were cancer patients. Overall, we found similar age adjusted rates of COVID-19 in the population with cancer as in the population without cancer. Unadjusted analysis showed that patients having undergone major surgery within the past 3 months had an increased risk of COVID-19 while we did not find increased Odds Ratio (OR) related to other oncological treatment modalities. No patients treated with stem cell or bone marrow transplant were diagnosed with COVID-19. The fatality rate of COVID-19 among cancer patients was 0.10. This was similar to non-cancer patients, when adjusting for age and sex with OR (95% CI) for death= 0.99 (0.68–1.42). Patients with distant metastases had significantly increased OR of death due to COVID-19 disease of 9.31 (95% CI 2.60–33.34). For the combined outcome death and/or admittance to hospital due to COVID-19, we found significant two-fold increased risk estimates for patients diagnosed with cancer less than one 1 year ago (OR 2.08, 95% CI 1.14–3.80), for those treated with anti-cancer drugs during the past 3 months (OR 1.80, 95% CI 1.07–3.01) and for patients undergoing major surgery during the past 3 months (OR 2.19, 95% CI 1.40–3.44).

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Revascularization Outcomes in Patients With Acute Limb Ischemia and Active Neoplastic Disease

Journal of Endovascular Therapy ◽

10.1177/1526602820954285 ◽

2020 ◽

pp. 152660282095428

Author(s):

Angeliki Argyriou ◽

Alexandros Kafetzakis ◽

Athanasios Saratzis ◽

Bella Huasen ◽

Raphaël Coscas ◽

...

Keyword(s):

Overall Survival ◽

Cox Regression ◽

Treatment Options ◽

Limb Ischemia ◽

Free Time ◽

Neoplastic Disease ◽

Acute Limb Ischemia ◽

Cox Regression Analysis ◽

Increased Risk ◽

Common Diagnosis

Purpose To report the outcomes of surgical (ST), endovascular (ET), and hybrid (HT) treatment in cancer patients with acute limb ischemia (ALI). Materials and Methods A multicenter retrospective registry collected 139 patients (mean age 72.3±12.4 years; 73 men) with ALI and active malignancy treated by ET (41, 29%), ST (70, 51%), or HT (28, 20%) in 7 European centers between July 2007 and February 2019. In 22 cases (16%) ALI was the first manifestation of the malignancy. Lung cancer was the most common diagnosis (38, 27%). The primary composite outcome was amputation-free survival (AFS). Overall survival, amputation-free time (AFT), and reintervention-free time (RFT) were also assessed. Cox regression analysis was applied to identify independent risk factors for the primary and secondary outcomes. Results are presented as the hazard ratio (HR) and 95% confidence intervals (CIs). Results ET was associated with improved 12-month AFS compared with both ST (HR 2.27, 95% CI 1.20 to 4.28, p=0.002) and HT (HR 2.14, 95% CI 1.09 to 4.18, p=0.008). ST (HR 2.50, 95% CI 1.19 to 5.53, p=0.003) and HT (HR 3.10, 95% CI 1.45 to 6.65, p<0.001) were related to an increased risk for mortality compared with ET. At 12 months, the AFT was similar between the 3 groups (ET vs ST: HR 1.52, 95% CI 0.51 to 4.53, p=0.45 and ET vs HT: HR 1.21, 95% CI 0.36 to 4.11, p=0.73). The 12-month RFT also did not differ significantly between the 3 treatment options (ET vs ST: HR 1.10, 95% CI 0.49 to 2.46, p=0.79 and ET vs HT: HR 0.51, 95% CI 0.22 to 1.17, p=0.19). ST and/or HT increased the risk for the major amputation and/or death (HR 1.76, 95% CI 1.05 to 2.05, p=0.03), while Rutherford class I ischemia (HR 0.12, 95% CI 0.02 to 0.90, p=0.04) and previous vascular interventions on the index limb (HR 0.55, 95% CI 0.32 to 0.97, p=0.04) showed a protective effect. Conclusion In patients with ALI and active malignant disease, ET was associated with increased AFS and overall survival compared with both ST and HT, while the limb salvage and reintervention rates were comparable among the 3 groups.

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The interrelationship between cerebral ischemic stroke and glioma: a comprehensive study of recent reports

Signal Transduction and Targeted Therapy ◽

10.1038/s41392-019-0075-4 ◽

2019 ◽

Vol 4 (1) ◽

Cited By ~ 2

Author(s):

Mrinal K. Ghosh ◽

Dipankar Chakraborty ◽

Sibani Sarkar ◽

Arijit Bhowmik ◽

Malini Basu

Keyword(s):

Ischemic Stroke ◽

Cancer Cells ◽

Cancer Patients ◽

Early Stage ◽

Significant Risk ◽

Patient Death ◽

Stroke Patients ◽

Increased Risk ◽

Cerebral Ischemic Stroke ◽

Cerebral Ischemic

Abstract Glioma and cerebral ischemic stroke are two major events that lead to patient death worldwide. Although these conditions have different physiological incidences, ~10% of ischemic stroke patients develop cerebral cancer, especially glioma, in the postischemic stages. Additionally, the high proliferation, venous thrombosis and hypercoagulability of the glioma mass increase the significant risk of thromboembolism, including ischemic stroke. Surprisingly, these events share several common pathways, viz. hypoxia, cerebral inflammation, angiogenesis, etc., but the proper mechanism behind this co-occurrence has yet to be discovered. The hypercoagulability and presence of the D-dimer level in stroke are different in cancer patients than in the noncancerous population. Other factors such as atherosclerosis and coagulopathy involved in the pathogenesis of stroke are partially responsible for cancer, and the reverse is also partially true. Based on clinical and neurosurgical experience, the neuronal structures and functions in the brain and spine are observed to change after a progressive attack of ischemia that leads to hypoxia and atrophy. The major population of cancer cells cannot survive in an adverse ischemic environment that excludes cancer stem cells (CSCs). Cancer cells in stroke patients have already metastasized, but early-stage cancer patients also suffer stroke for multiple reasons. Therefore, stroke is an early manifestation of cancer. Stroke and cancer share many factors that result in an increased risk of stroke in cancer patients, and vice-versa. The intricate mechanisms for stroke with and without cancer are different. This review summarizes the current clinical reports, pathophysiology, probable causes of co-occurrence, prognoses, and treatment possibilities.

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Integrin genetic variants and risk of thromboembolic events in patients with colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.462 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 462-462

Author(s):

Gerald Prager ◽

Alexandra Schuler ◽

Cihan Ay ◽

Clemens Pausz ◽

Heinz-Josef Lenz ◽

...

Keyword(s):

Colorectal Cancer ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Tumor Biology ◽

Multivariable Analysis ◽

Significant Risk ◽

Direct Dna Sequencing ◽

Increased Risk ◽

Colorectal Cancer Patients ◽

Integrin Beta 3

462 Background: Patients with colorectal cancer are at increased risk of venous thromboembolism (VTE). Integrin beta-3 are involved in tumor biology as well as platelet aggregation, thus, we tested as a primary endpoint whether a comprehensive panel of germline single nucleotide polymorphisms (SNPs) in the integrin beta-3 gene could predict the risk of VTE in colorectal cancer patients. Methods: The study population comprises patients recruited into the Vienna Cancer and Thrombosis Study (CATS) (Ay, C et al; JCO 2011 vol. 29 no. 15), an ongoing prospective observational cohort study initiated in October 2003 at the Medical University of Vienna. In 114 out of 139 patients diagnosed with colon cancer DNA was assessable for integrin beta-3 germline SNPs rs3809865, rs5918, rs4642 characterization. Whole blood samples were analyzed using PCR-RFLP or direct DNA-sequencing. VTE events were statistical analyzed using one-way Anova testing. Results: The patient’s demographics and tumor characteristics were balanced between groups. VTE occurred in 14 patients (12.28%). In colorectal cancer patients with an rs3809865 A/A allele profile a statistical significant (p=0.0015) increased risk of VTE events was observed as 12 (25%) of 48 patients experienced VTE. Only 2 of 52 patients (3.85%) harboring an A/T allele VTE was diagnosed. None (0%) of the T/T subgroup had any VTE. Other SNPs revealed no predictive value for VTE. In multivariable analysis including age, sex, chemotherapy, and anti-VEGF therapy rs3809865 A/A allele profile remained a statistical significant risk factor for VTE. Conclusions: This study identifies germline polymorphisms in integrin genes as independent prognostic markers for VTE in colorectal cancer. These data may help to select subgroups of patients who may benefit from an enforced prophylaxis of venous thromboembolism (VTE).

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Acute limb ischemia in cancer patients: Aggressive treatment is justified

Vascular ◽

10.1177/1708538114537048 ◽

2014 ◽

Vol 23 (1) ◽

pp. 55-61 ◽

Cited By ~ 3

Author(s):

Daniel Silverberg ◽

Tal Yalon ◽

Emanuel R Reinitz ◽

Dmitry Yakubovitch ◽

Tal Segev ◽

...

Keyword(s):

Cancer Patients ◽

Survival Rates ◽

Limb Ischemia ◽

Major Amputation ◽

Acute Limb Ischemia ◽

Aggressive Treatment ◽

Perioperative Mortality ◽

Term Survival

Background The outcome of cancer patients with acute limb ischemia (ALI) is not well defined. The purpose of this study is to report our experience treating patients with active malignancy who developed ALI and compare their outcome with non-cancer patients. Methods A retrospective review of patients treated for ALI between 2009 and 2012 with ALI. We identified those patients who suffered from ALI and compared the outcome of those with active malignancy to those without malignancy. Results Of 147 patients treated for ALI (122 lower extremity, 25 upper extremity), 24 (16%) were cancer patients. Mean follow-up was 9.8 months for the malignancy group and 13.4 months for the control. Perioperative mortality rates were similar among cancer and non-cancer patients (20% vs. 16%, respectively, NS). Freedom from major amputation at 30 months was similar (95% vs. 89%, NS). Long-term survival rates of cancer patients were significantly lower compared to non-cancer patients (45% vs. 77% respectively, P < 0.05). Conclusions Treatment of ALI among cancer patients can be achieved with perioperative mortality and limb salvage rates comparable to non-cancer patients. Aggressive treatment is justified when treating cancer patients with ALI.

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