scholarly journals A catastrophic seronegative anti-phospholipid syndrome: case and literature review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Vanda Pinto ◽  
Augusto Ministro ◽  
Nuno Reis Carreira ◽  
Ana Cardoso ◽  
Catarina Sousa Gonçalves ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
High Mortality ◽  
Pulmonary Arteries ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Renal Infarction ◽  
Vascular Events ◽  
Intensive Care Unit Treatment ◽  
Serological Tests ◽  
Hospital Emergency Room

Abstract Background Antiphospholipid Syndrome (APS) is a multisystemic autoimmune disease characterized by arterial and venous thrombosis and / or obstetric morbidity in the presence of at least one circulating anti-phospholipid antibody. The spectrum of vascular events varies from deep venous thrombosis to catastrophic APS, a rare form characterized by acute multiorgan thrombosis and high mortality. Case report We present the case of a 32-week pregnant woman arriving in the hospital emergency room with bilateral acute lower limb ischemia. In the obstetric evaluation, fetal death was declared. Computerized Tomography angiography showed pulmonary embolism of both pulmonary arteries, areas of splenic and right renal infarction and multiple arterial and venous thrombosis. The patient underwent urgent caesarean section and axillary-bifemoral bypass. No events registered. In the postoperative period, in an intensive care unit, treatment with rituximab and plasmapheresis were added to anticoagulant therapy. The laboratorial investigation was negative for thrombophilia and autoimmune diseases. Conclusion Catastrophic APS develops quickly, with multiorgan involvement and high mortality rate. The presented case poses a multidisciplinary challenge, with the surgical approach of extra-anatomical revascularization being less invasive and guaranteeing immediate perfusion of the lower limbs. Although the serological tests were negative for anti-phospholipid antibodies, this case hardly fits into another diagnosis. Therefore, it was treated as a catastrophic APS, having shown a favorable evolution.

scholarly journals Diffuse prothrombotic syndrome after ChAdOx1 nCoV-19 vaccine administration: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Nicole Ceschia ◽  
Valentina Scheggi ◽  
Anna Maria Gori ◽  
Angela Antonietta Rogolino ◽  
Francesca Cesari ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Vitamin K Antagonists ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Medical Community ◽  
Caucasian Woman ◽  
Acute Limb Ischemia ◽  
Ischemic Lesion ◽  
Hospitalization Period

Abstract Background Vaccine-induced immune thrombotic thrombocytopenia is emerging as one of the most relevant side effects of adenoviral-based vaccines against coronavirus disease 2019. Given the novelty of this disease, the medical community is seeking new evidence and clinical experiences on the management of these patients. Case presentation In this article, we describe the case of a 73-year-old Caucasian woman who presented with diffuse prothrombotic syndrome, both in the arterial and venous districts, following the first dose administration of ChAdOx1 CoV-19 vaccine. The main thrombotic sites included the brain, with both a cortical ischemic lesion and thromboses of the left transverse and sigmoid sinuses and the lower limbs, with deep venous thrombosis accompanied by subsegmental pulmonary thromboembolism. The deep venous thrombosis progressively evolved into acute limb ischemia, requiring surgical intervention with thromboendoarterectomy. Anticoagulation was maintained throughout the whole hospitalization period and continued in the outpatient setting using vitamin K antagonists for a recommended period of 6 months. Conclusions This case describes the management of vaccine-induced immune thrombotic thrombocytopenia in a complicated clinical scenario, including multisite arterial and venous thromboses. Given the complexity of the patient presentation, this case may implement the comprehension of the mechanisms and clinical features of this disease; it also provides a picture of the challenges related to the management, often requiring a multidisciplinary approach.

Use of intravenous alprostadil in patients with severe critical ischemia of the lower limbs

Vascular ◽  
2018 ◽  
Vol 27 (3) ◽  
pp. 318-323
Author(s):  
Jorge Enrique Machado-Alba ◽  
Manuel E Machado-Duque
Keyword(s):  
Critical Limb Ischemia ◽  
Adverse Reactions ◽  
Limb Ischemia ◽  
Cross Sectional Study ◽  
Lower Limbs ◽  
Critical Ischemia ◽  
Cross Sectional ◽  
Potential Benefits ◽  
Advanced Stages ◽  
Clinical Records

Objectives To determine the indications for the use, potential benefits, and adverse reactions of alprostadil in a group of Colombian patients. Methods A retrospective cross-sectional study was conducted in patients diagnosed with critical limb ischemia who received alprostadil in five hospitals in Colombia between September 2011 and July 2017. We reviewed the clinical records of each patient to obtain the sociodemographic and pharmacological variables, clinical stages, complications, comorbidities, reported effectiveness and adverse reactions. Results Sixty-one patients treated with alprostadil were evaluated; 50.8% of patients were men, and the average age of 72.5 ± 10.7 years. A total of 86.9% of patients were hypertensive, and 65.6% were diabetic. A total of 77.0% presented ulceration, and this condition was considered as a diabetic foot in 57.4% of patients. A total of 81.9% of patients were classified as Fontaine stage 4; 60.7% received therapy as initially indicated, with an average of 19 days of alprostadil use. Regarding the therapy results, 58.0% of the patients with ulcers or trophic lesions showed improvement, 86.2% showed improvement of pain, and the limb was saved in 72.1% of patients. Conclusions Critical limb ischemia was presented by patients with advanced age and high cardiovascular risk who were treated during severe and advanced stages where therapeutic options are limited. Treatment with alprostadil achieved satisfactory results with improvement in ulcers, pain, and limb salvage rates in this series of patients.

Evaluation of foot hypoperfusion and estimation of percutaneous transluminal angioplasty outcome in patients with critical limb ischemia using intravoxel incoherent motion microperfusion MRI

2021 ◽  
pp. 20210215
Author(s):  
Nikolaos Galanakis ◽  
Thomas G Maris ◽  
Georgios Kalaitzakis ◽  
Nikolaos Kontopodis ◽  
Nikolas Matthaiou ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Percutaneous Transluminal Angioplasty ◽  
Ankle Brachial Index ◽  
Limb Ischemia ◽  
Transluminal Angioplasty ◽  
Lower Limbs ◽  
Intravoxel Incoherent Motion ◽  
Healthy Individuals ◽  
Imaging Protocol ◽  
Percutaneous Transluminal

Objectives: To emerge hypoperfusion of lower limbs in patients with critical limb ischemia (CLI) using Intravoxel Incoherent Motion microperfusion magnetic resonance imaging (IVIM-MRI). Moreover to examine the ability of IVIM-MRI to differentiate patients with severe peripheral arterial disease (PAD) from normal subjects and evaluate the percutaneous transluminal angioplasty (PTA) results in patients with CLI. Methods: Eight patients who presented with CLI and six healthy volunteers were examined. The patients underwent IVIM-MRI of lower extremity before and following PTA. The imaging protocol included sagittal diffusion-weighted (DW) sequences. DW images were analyzed and color parametric maps of the micro-circulation of blood inside the capillary network (D*) were constructed. The studies were evaluated by two observers to define interobserver reproducibility. Results: Technical success was achieved in all patients (8/8). The mean ankle-brachial index increased from 0.35 ± 0.2 to 0.76 ± 0.25 (p < 0.05). Successful revascularization improved IVIM microperfusion. Mean D* increased from 279.88 ± 13.47 10−5 mm2/s to 331.51 ± 31 10−5 mm2/s, following PTA, p < 0.05. Moreover, PAD patients presented lower D* values as compared to healthy individuals (279.88 ± 13.47 10−5 mm2/s vs 332.47 ± 22.95 10−5 mm2/s, p < 0.05, respectively). Good interobserver agreement was obtained with an ICC = 0.84 (95% CI 0.64–0.93). Conclusions: IVIM-MRI can detect differences in microperfusion between patients with PAD and healthy individuals. Moreover, significant restitution of IVIM microperfusion is found following successful PTA. Advances in knowledge: IVIM-MRI is a safe, reproducible and effective modality for evaluation of lower limb hypoperfusion in patients with PAD. It seems also to be a helpful tool to detect changes of tissue perfusion in patients with CLI following revascularization.

scholarly journals A Case of Bilateral Acute Inferior Limb Ischemia in a Patient With Ulcerative Colitis

2020 ◽  
Vol 13 ◽  
pp. 117954762091273
Author(s):  
Mimari Kanazawa ◽  
Takeshi Sugaya ◽  
Fumiaki Takahashi ◽  
Kazuhiro Takenaka ◽  
Kouhei Tsuchida ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Blood Flow ◽  
Balloon Catheter ◽  
Limb Ischemia ◽  
Lower Limbs ◽  
Bloody Stool ◽  
Mayo Score ◽  
High Incidence ◽  
Inflammatory Bowel ◽  
Inferior Limb

A patient was diagnosed with ulcerative colitis (UC) in 2010. In March 2015, she had abdominal pain, diarrhea, bloody stool, and UC has relapsed. In June 2015, pain and sensory disturbance of both lower limbs appeared. Blood flow at the distal femoral artery was not confirmed with magnetic resonance angiography, and it was diagnosed as bilateral acute inferior limb ischemia. Arterial thrombolectomy with Fogarty’s balloon catheter was performed and blood flow was improved. The severity of UC was moderate with Mayo score 8. Thrombosis is considered to be a complication with a high incidence in inflammatory bowel disease. Reports of arterial thrombosis are very rare. It is important to evaluate the risk of bleeding and thrombosis in active or severe cases in UC and need to do thrombotic prophylactic treatment simultaneously with UC treatment.

scholarly journals Home versus in-hospital treatment of outpatients with acute deep venous thrombosis of the lower limbs

2014 ◽  
Vol 59 (5) ◽  
pp. 1362-1367.e1 ◽  
Author(s):  
Francisco Lozano ◽  
Javier Trujillo-Santos ◽  
Manuel Barrón ◽  
Pedro Gallego ◽  
Dimitrios Babalis ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lower Limbs ◽  
Hospital Treatment

Idiopathic spontaneous extensive iliocaval thrombosis presenting with renal infarct

2020 ◽  
Vol 13 (6) ◽  
pp. e234957
Author(s):  
Naveen Kumar ◽  
Aneesh Srivastava ◽  
Navneet Mishra ◽  
Hira Lal
Keyword(s):  
Inferior Vena Cava ◽  
Venous Thrombosis ◽  
Rare Case ◽  
Inferior Vena ◽  
Vena Cava ◽  
Renal Infarction ◽  
Renal Veins ◽  
Renal Infarct

We describe an extremely rare case of idiopathic spontaneous extensive venous thrombosis in a young man involving the inferior vena cava, the iliac veins and both renal veins associated with right haemorrhagic renal infarction with non-functioning right kidney.

Deep venous thrombosis of lower limbs in adolescents: a study in a tertiary hospital

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Catarina Faria ◽  
Henedina Antunes ◽  
Teresa Pontes ◽  
Ana Antunes ◽  
Sofia Martins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Oral Contraceptive ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Positive Family History ◽  
Oral Contraceptive Pill ◽  
Tertiary Hospital ◽  
Lower Limbs ◽  
Factor V Leiden Mutation

AbstractBackgroundVenous thromboembolism (VTE) – which includes deep venous thrombosis (DVT) and pulmonary embolism (PE) – has been increasingly recognized in the pediatric population. The estimated incidence is 0.07–0.14 cases per 10,000 children. Most cases are associated with two or more risk factors. Medium and long-term complications include recurrence and post-thrombotic syndrome (PTS).ObjectiveTo characterize the adolescent population with the diagnosis of DVT of lower limbs in a tertiary hospital, regarding its clinical presentation, associated risk factors, treatment and outcome.MethodsRetrospective analysis of adolescents with the diagnosis of DVT of lower limbs in our hospital for a period of 7 years.ResultsEight patients were identified; seven were females; median age was 15 years. The main symptoms were local pain and edema. Left lower limb was affected in six patients. PE occurred in two cases. Positive family history of venous thromboembolism was found in five patients. Seven patients had at least two identifiable risk factors. Combined oral contraceptive pill use was the most common (seven patients). Factor V Leiden mutation was found in three patients and protein C deficiency in one. Iliac vein compression syndrome was diagnosed in one patient. The median time for discharge was 8 days. Election treatment was enoxaparin followed by warfarin, for a median period of 10.9 months. Three patients developed PTS.ConclusionsAlthough uncommon, VTE is an emerging reality in adolescents, particularly in females using oral contraceptive pills. Appropriated prevention strategies and treatment are required as most orientations are extrapolated from adults.

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