scholarly journals Case Report: An Unusual Case of Acute Lower Limb Ischemia as Precursor of the Asherson's Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Edoardo Pasqui ◽  
Silvia Camarri ◽  
Gianmarco de Donato ◽  
Stefano Gonnelli ◽  
Giancarlo Palasciano ◽  
...  
Keyword(s):  
Lower Limb ◽  
Thrombotic Event ◽  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Limb Amputation ◽  
High Dose ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Acute Limb Ischemia ◽  
Tibial Arteries

Introduction: Asherson's Syndrome, also defined as Catastrophic Antiphospholipid Syndrome (CAPS), represents the most severe manifestation of Antiphospholipid Antibody Syndrome. Rarely, the first CAPS diagnosis is based on macro-thrombotic event as acute limb ischemia.Case Presentation: We present a case of a 65-year-old woman admitted with an acute lower limb arterial ischemia with a complete occlusion of all the three tibial vessels. Three endovascular recanalization procedures were performed contemporary to 48 h intraarterial thrombolysis administration. The patency of tibial arteries was restored with a near-complete absence of digital arteries and microvessel perfusion of the foot. In the following days, an aggressive foot gangrene was established, leading to a major lower-limb amputation. Due to the general clinical status worsening and aggressiveness of ischemic condition, further investigations were performed leading to the diagnosis of an aggressive Asherson's Syndrome that was also complicated by a severe heparin-induced thrombocytopenia. Medical management with a high dose of intravenous steroids and nine sessions of plasma exchange led to a clinical condition stabilization.Conclusion: In our case, the presence of a “sine causa” acute arterial occlusion of a large vessel represented the first manifestation of an aggressive form of Asherson's Syndrome that could represent a fatal disease. Due to the extreme variety of manifestations, early clinical suspicion, diagnosis, and multidisciplinary management are essential to limit the life-threatening consequences of patients.

Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽  
2020 ◽  
pp. 1-6 ◽  
Author(s):  
Marina Di Pilla ◽  
Stefano Barco ◽  
Clara Sacco ◽  
Giovanni Barosi ◽  
Corrado Lodigiani
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Lower Limb ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Review Of The Literature ◽  
Heparin Induced Thrombocytopenia ◽  
Lower Limb Ischemia ◽  
Vein Thrombosis ◽  
Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

Potential Benefits From Heating the High-Dose rtPA Boluses Used in Catheter-Directed Thrombolysis for Acute/Subacute Lower Limb Ischemia

2003 ◽  
Vol 10 (4) ◽  
pp. 739-744 ◽  
Author(s):  
Dimitrios K. Tsetis ◽  
Asterios N. Katsamouris ◽  
Athanasios D. Giannoukas ◽  
Adam A. Hatzidakis ◽  
Theodoros Kostas ◽  
...  
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
High Dose ◽  
Lower Limb Ischemia ◽  
Catheter Directed Thrombolysis ◽  
Potential Benefits

Influence of diabetes on diagnostic performance of computed tomography angiography of the calf arteries in acute limb ischemia

2021 ◽  
pp. 028418512110069
Author(s):  
Talha Butt ◽  
Leena Lehti ◽  
Jan Apelqvist ◽  
Anders Gottsäter ◽  
Stefan Acosta
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Diagnostic Performance ◽  
Intraclass Correlation ◽  
Arterial Occlusion ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Acute Limb Ischemia ◽  
Below The Knee

Background Patients with diabetes mellitus (DM) have a more extensive distal arterial occlusive disease compared to non-diabetic patients. Diagnostic imaging is a necessity to identify the location and extent of the arterial occlusion in acute limb ischemia (ALI). Computed tomography angiography (CTA) is the most commonly used modality and the diagnostic performance with CTA of calf arteries may be questioned. Purpose To evaluate diagnostic performance of CTA of calf arteries in ALI and to compare patients with and without DM. Material and Methods All thrombolytic treatments performed during 2001–2008 in patients with ALI were included. Initial digital subtraction angiography (DSA) and CTA of all patients were classified according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) below-the-knee arteries and compared to CTA. Two raters assessed the CTA images independently. Inter-rater reliability was expressed as intraclass correlation (ICC) with 95% confidence intervals (CI). Results Patients with (n = 23) and without (n = 85) DM had lower ( P = 0.006) glomerular filtration rate. ICC between CTA and DSA was 0.33 (95% CI –0.22 to 0.56) and 0.71 (95% CI 0.38–0.68) in patients with and without DM, respectively. Sensitivity with CTA for TASC D lesions in patients with and without DM was 0.14 (95% CI –0.12 to 0.40) and 0.64 (95% CI 0.48–0.80), respectively. Conclusion The sensitivity of CTA for assessment of infra-popliteal TASC D lesions in patients with ALI was not acceptable in patients with DM in contrast to those without DM. Another imaging option at present times should be considered for patients with DM.

Missed hypereosinophilic syndrome in a critically ill patient with systemic lupus erythematosus

2021 ◽  
Vol 14 (1) ◽  
pp. e236592
Author(s):  
Ying Ling ◽  
Mary Jane Bell ◽  
Lisa Chodirker ◽  
Shirley Lake
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Hypereosinophilic Syndrome ◽  
Clinical Manifestations ◽  
Critically Ill Patient ◽  
Total Leucocyte Count ◽  
High Dose ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Systemic Lupus

A high functioning 74-year-old man with systemic lupus erythematosus presented to the emergency department with acute anxiety. He was found to have elevated cardiac enzymes and admitted to the cardiology service for investigation. In hospital, he developed an erythematous papular rash, and deteriorated to being somnolent and bedridden. He was found to have new multiterritory ischaemic strokes. It was eventually noted that he had persistent eosinophilia, present even on admission, which had been overlooked as the total leucocyte count was normal. Serology for antiphospholipid antibody syndrome (APS) was positive. He was diagnosed with hypereosinophilic syndrome (HES) secondary to new APS, and responded to high-dose steroids. This case highlights the importance of fully evaluating a leucocyte differential to make a diagnosis of HES. We discuss the definition, clinical manifestations, diagnostic approach and management of this important condition.

scholarly journals A case of acute limb ischemia

2021 ◽  
Vol 8 (10) ◽  
pp. 1608
Author(s):  
Kshiti Rai ◽  
K. G. Sajeeth Kumar ◽  
Danish Ekkalayil ◽  
Anoop Chanthu K. K.
Keyword(s):  
Acute Myeloid Leukemia ◽  
Early Diagnosis ◽  
Lower Limb ◽  
Myeloid Leukemia ◽  
Hematological Malignancy ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Rare Presentation ◽  
Hematological Evaluation ◽  
Acute Myeloid

Thromboembolism is a well-recognized complication of hematological malignancy. The incidence of symptomatic thrombosis at diagnosis is relatively low in AML (acute myeloid leukemia) patients, though its incidence increases on treatment with anthracyclines. We reported a case of 69 year old female with T2DM who presented with DVT and later on acute limb ischemia of the same lower limb. On hematological evaluation, she had leukocytosis and thrombocytopenia. Further evaluation revealed AML. Thromboembolism as a rare presentation of AML in adults with leukemic hyperleukocytosis has seldom been reported. In the absence of clear guidelines, early diagnosis and management are desirable.

scholarly journals Successful Pregnancy Outcome with High dose Heparin Therapy in Antiphospholipid Antibody Syndrome

1970 ◽  
Vol 11 (2) ◽  
pp. 205-206
Author(s):  
MP Ranjith ◽  
Ranjith Divya ◽  
S Meera ◽  
Shabu Bahuleyan ◽  
Roney Joseph Kuryan
Keyword(s):  
Antiphospholipid Antibodies ◽  
Heparin Therapy ◽  
High Dose ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Syndrome Patient ◽  
Successful Pregnancy ◽  
Dose Heparin ◽  
History Of ◽  
Recurrent Abortions

Antiphospholipid antibody syndrome is an autoimmune disease characterized by thrombosis, both arterial andvenous, recurrent spontaneous abortion and the persistence of positive antiphospholipid antibodies. Placentalthrombosis is believed to be the cause of recurrent abortions, characteristic of the syndrome. We report a pregnantwith antiphospholipid antibody syndrome patient with history of recurrent miscarriages and managed successfullywith high dose heparin.Keywords: Antiphospholipid antibody syndrome; recurrent intra uterine death; HeparinDOI: 10.3329/jom.v11i2.5476J MEDICINE 2010; 11 : 205-206

scholarly journals Contemporary Management of Acute Lower Limb Ischemia: Determinants of Treatment Choice

2020 ◽  
Vol 9 (5) ◽  
pp. 1501
Author(s):  
Aleksander Lukasiewicz
Keyword(s):  
Lower Limb ◽  
Limb Ischemia ◽  
Lower Limb Ischemia ◽  
Factors Affecting ◽  
Tibial Arteries ◽  
Contemporary Management ◽  
Active Cancer ◽  
Selection Of ◽  
Concurrent Cancer

The role of endovascular procedures in the treatment of acute lower limb ischemia (ALI) is expanding. For treatment, the choice between surgical or endovascular is still debated. The aim of this study was to identify factors that determine the selection of treatment. This study included 307 ALI patients (209 with thrombosis). Patient details, factors affecting the procedure choice, and outcomes were analyzed. The majority of patients were operated on (52.4%). Surgery was more frequent in embolic patients with embolus (odds ratio (OR) 33.85; 95% confidence interval (CI) 6.22–184.19, p < 0.0001), severe ischemia (OR 1.79; 95% CI 1.2–2.66, p = 0.0041), and active cancer (OR 4.99; 95% CI 1.26–19.72, p = 0.02). Tibial arteries involvement was negatively related to surgery (OR 0.25; 95% CI 0.06–0.95, p = 0.04). The complications and amputation rates were comparable. Reinterventions were more common in the endovascular group (19 (20.2%) vs. 17 (8.9%), p = 0.007). The six-month mortality was higher in the operated patients (12.6% vs. 3.2%, respectively, p = 0.001). The determinants of the treatment path are ischemia severity, concurrent cancer, embolus, and peripheral lesion location. Modification of the Rutherford acute lower limb ischemia classification is required to improve the decision-making in patients with profound ischemia.

scholarly journals P853 Bilateral lower limb ischemia in a healthy young man what if the heart was hiding the etiology

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Mouadili ◽  
A Tamdy ◽  
B El Fatmi ◽  
S Elkarimi
Keyword(s):  
Popliteal Artery ◽  
Lower Limb ◽  
Cardiac Myxoma ◽  
Clinical Manifestations ◽  
Limb Ischemia ◽  
Atrial Myxoma ◽  
Surgical Removal ◽  
Left Atrial Myxoma ◽  
Tibial Arteries ◽  
The Right

Abstract Cardiac myxoma is the most common benign cardiac tumor with diverse nonspecific clinical manifestations; moreover, atrial myxoma embolization to the peripheral vessels is rare. A 24-year-old man presented tothe emergency departement complaining ofpain and coldness of his two lower extremities. The right femoral pulse was normally felt while the pulses of the left lower limb from the femoral down to the posterior and anterior tibial arteries were not felt. Bilateral thrombectomy was performed on emergency basisand a fatty-like mass from the left femoral artery was removed. The histological examination of this mass was suggestive of myxoma.So, transthoracic echocardiography was done and confirmed the diagnosis of myxoma that was seen in the left atrium and measuring about 10X6 cm in its maximal dimensions. Surgical removal of the myxoma was done later and the patient recovered uneventfully. Conclusion Although myxomas are rare, they should be considered in the differential diagnosis of peripheral embolic disease, especially when an embolic event occurs in a young adult without evidence of endocarditis or arrhythmia. Echocardiography is the modality of choice for diagnosis and follow-up of this type of tumors. FIGURE 1: CTA (computed tomography angiography) showing Occlusion of the left popliteal artery and occlusion of the distal part of the right popliteal artery FIGURE 2: macroscopic view of gelatinous left atrial myxoma

scholarly journals Antiphospholipid Antibody Syndrome Associated with Graves' Disease Presenting as Inferior Vena Cava Thrombosis with Bilateral Lower Limb DVT

2014 ◽  
Vol 7 ◽  
pp. CCRep.S15302 ◽  
Author(s):  
Ankur Jain
Keyword(s):  
Inferior Vena Cava ◽  
Lower Limb ◽  
Inferior Vena ◽  
Case Reports ◽  
Vena Cava ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Bilateral Lower Limb

We report a case of a 60-year-old lady who presented with bilateral lower limb swelling and a thyroid swelling with clinical features consistent with thyrotoxicosis. Investigations revealed the presence of a thrombus in bilateral external, internal iliac veins, and inferior vena cava extending up to its infrahepatic part. Hormone profile and radioiodine uptake scan confirmed the diagnosis of Graves' disease. Further workup revealed the presence of antiphospholipid antibodies (confirmed after a repeat test at 12 weeks). The patient was treated with antithyroid drugs and anticoagulants. The patient improved with normalization of thyroid function and partial recanalization of the infrahepatic part of inferior vena cava. Hyperthyroidism has been implicated as a potential hypercoagulable state; however, the association of Graves' disease with antiphospholipid antibody syndrome is limited to isolated case reports. This case highlights a new mechanism underlying hypercoagulability associated with Graves' disease.

Hypoxia-Inducible Factor 1 in Lower Limb Ischemia

Vascular ◽  
2006 ◽  
Vol 14 (6) ◽  
pp. 321-327 ◽  
Author(s):  
Teik K. Ho ◽  
David J. Abraham ◽  
Carol M. Black ◽  
Daryll M. Baker
Keyword(s):  
Skeletal Muscle ◽  
Lower Limb ◽  
Target Genes ◽  
Therapeutic Potential ◽  
Hypoxia Inducible Factor ◽  
Limb Ischemia ◽  
Limb Amputation ◽  
Western World ◽  
High Morbidity ◽  
Activity Increase

In the Western world, peripheral vascular disease (PVD) has a high prevalence and is associated with high morbidity and mortality. More patients are presenting with critical limb ischemia (CLI), the end stage of PVD, because of an increased life expectancy owing to improved medical care. In a large percentage of these patients, lower limb amputation is still required, despite current advances in surgery and interventional radiology. Studies of ischemic skeletal muscles disclosed evidence of endogenous angiogenesis and adaptive skeletal muscle metabolic changes in response to hypoxia. Many of the genes responsible for these responses are regulated by hypoxia-inducible factor (HIF)-1. HIF-1, consisting of HIF-1α and HIF-1β subunits, is a major transcription factor that functions as a master regulator of oxygen homeostasis that plays essential roles in cellular and systemic pathophysiology. HIF-1α expression and HIF-1 transcriptional activity increase exponentially as cellular oxygen concentration is decreased. More than 60 target genes that are transactivated by HIF-1 have been identified. Many of the target genes, such as vascular endothelial growth factor, have been studied extensively, especially in tumors. However, only recently that interest in HIF-1 is growing in relation to ischemic diseases. Most of the studies concentrated mainly on the angiogenic property of HIF-1. In contrast, there is a lack of information on the role of HIF-1 in skeletal muscle metabolic adaptive changes as the end-organ in PVD. This review aims to summarize our current understanding of HIF-1 roles and the therapeutic potential in PVD.

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