Acute limb ischemia in cancer patients: should we surgically intervene?

Hdl Handle:
http://hdl.handle.net/10147/207031
Title:
Acute limb ischemia in cancer patients: should we surgically intervene?
Authors:
Tsang, Julian S; Naughton, Peter A; O'Donnell, Jill; Wang, Tim T; Moneley, Daragh S; Kelly, Cathal J; Leahy, Austin L
Affiliation:
Department of Vascular Surgery, Royal College of Surgeons Ireland, Beaumont, Hospital, Dublin, Ireland. julianst@yahoo.com
Citation:
Ann Vasc Surg. 2011 Oct;25(7):954-60. Epub 2011 Aug 6.
Journal:
Annals of vascular surgery
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207031
DOI:
10.1016/j.avsg.2011.06.002
PubMed ID:
21821390
Abstract:
BACKGROUND: Cancer patients have an increased risk of venous thromboembolic events. Certain chemotherapeutic agents have also been associated with the development of thrombosis. Reported cases of acute arterial ischemic episodes in cancer patients are rare. METHODS: Patients who underwent surgery for acute limb ischemia associated with malignancy in a university teaching hospital over a 10-year period were identified. Patient demographics, cancer type, chemotherapy use, site of thromboembolism, treatment and outcome were recorded. RESULTS: Four hundred nineteen patients underwent surgical intervention for acute arterial ischemia, 16 of these patients (3.8%) had associated cancer. Commonest cancer sites were the urogenital tract (n = 5) and the lungs (n = 5). Eight patients (50%) had been recently diagnosed with cancer, and four (25%) of these cancers were incidental findings after presentation with acute limb ischemia. Four patients (25%) developed acute ischemia during chemotherapy. The superficial femoral artery was the most frequent site of occlusion (50%), followed by the brachial (18%) and popliteal (12%) arteries. All patients underwent thromboembolectomy, but two (12%) patients subsequently required a bypass procedure. Six patients (37%) had limb loss, and in-patient mortality was 12%. Histology revealed that all occlusions were due to thromboembolism, with no tumor cells identified. At follow-up, 44% of patients were found to be alive after 1 year. CONCLUSION: Cancer and chemotherapy can predispose patients to acute arterial ischemia. Unlike other reports that view this finding as a preterminal event most appropriately treated by palliative measures, in this series, early diagnosis and surgical intervention enabled limb salvage and patient survival.
Language:
eng
MeSH:
Acute Disease; Aged; Aged, 80 and over; Antineoplastic Agents/*adverse effects; Extremities/*blood supply; Female; Hospital Mortality; Hospitals, Teaching; Humans; Ireland; Ischemia/etiology/mortality/*surgery; Kaplan-Meier Estimate; Limb Salvage; Male; Middle Aged; Neoplasms/*complications/*drug therapy/mortality; Patient Selection; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; *Vascular Surgical Procedures/adverse effects/mortality; Venous Thromboembolism/etiology/mortality/*surgery
ISSN:
1615-5947 (Electronic); 0890-5096 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorTsang, Julian Sen_GB
dc.contributor.authorNaughton, Peter Aen_GB
dc.contributor.authorO'Donnell, Jillen_GB
dc.contributor.authorWang, Tim Ten_GB
dc.contributor.authorMoneley, Daragh Sen_GB
dc.contributor.authorKelly, Cathal Jen_GB
dc.contributor.authorLeahy, Austin Len_GB
dc.date.accessioned2012-02-01T09:57:36Z-
dc.date.available2012-02-01T09:57:36Z-
dc.date.issued2012-02-01T09:57:36Z-
dc.identifier.citationAnn Vasc Surg. 2011 Oct;25(7):954-60. Epub 2011 Aug 6.en_GB
dc.identifier.issn1615-5947 (Electronic)en_GB
dc.identifier.issn0890-5096 (Linking)en_GB
dc.identifier.pmid21821390en_GB
dc.identifier.doi10.1016/j.avsg.2011.06.002en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207031-
dc.description.abstractBACKGROUND: Cancer patients have an increased risk of venous thromboembolic events. Certain chemotherapeutic agents have also been associated with the development of thrombosis. Reported cases of acute arterial ischemic episodes in cancer patients are rare. METHODS: Patients who underwent surgery for acute limb ischemia associated with malignancy in a university teaching hospital over a 10-year period were identified. Patient demographics, cancer type, chemotherapy use, site of thromboembolism, treatment and outcome were recorded. RESULTS: Four hundred nineteen patients underwent surgical intervention for acute arterial ischemia, 16 of these patients (3.8%) had associated cancer. Commonest cancer sites were the urogenital tract (n = 5) and the lungs (n = 5). Eight patients (50%) had been recently diagnosed with cancer, and four (25%) of these cancers were incidental findings after presentation with acute limb ischemia. Four patients (25%) developed acute ischemia during chemotherapy. The superficial femoral artery was the most frequent site of occlusion (50%), followed by the brachial (18%) and popliteal (12%) arteries. All patients underwent thromboembolectomy, but two (12%) patients subsequently required a bypass procedure. Six patients (37%) had limb loss, and in-patient mortality was 12%. Histology revealed that all occlusions were due to thromboembolism, with no tumor cells identified. At follow-up, 44% of patients were found to be alive after 1 year. CONCLUSION: Cancer and chemotherapy can predispose patients to acute arterial ischemia. Unlike other reports that view this finding as a preterminal event most appropriately treated by palliative measures, in this series, early diagnosis and surgical intervention enabled limb salvage and patient survival.en_GB
dc.language.isoengen_GB
dc.subject.meshAcute Diseaseen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshAntineoplastic Agents/*adverse effectsen_GB
dc.subject.meshExtremities/*blood supplyen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHospital Mortalityen_GB
dc.subject.meshHospitals, Teachingen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIrelanden_GB
dc.subject.meshIschemia/etiology/mortality/*surgeryen_GB
dc.subject.meshKaplan-Meier Estimateen_GB
dc.subject.meshLimb Salvageen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.meshNeoplasms/*complications/*drug therapy/mortalityen_GB
dc.subject.meshPatient Selectionen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshRisk Assessmenten_GB
dc.subject.meshRisk Factorsen_GB
dc.subject.meshTime Factorsen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.subject.mesh*Vascular Surgical Procedures/adverse effects/mortalityen_GB
dc.subject.meshVenous Thromboembolism/etiology/mortality/*surgeryen_GB
dc.titleAcute limb ischemia in cancer patients: should we surgically intervene?en_GB
dc.contributor.departmentDepartment of Vascular Surgery, Royal College of Surgeons Ireland, Beaumont, Hospital, Dublin, Ireland. julianst@yahoo.comen_GB
dc.identifier.journalAnnals of vascular surgeryen_GB
dc.description.provinceLeinster-

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