Warncke C, Alberio L, Savolainen H, von Allmen R, Baumgartner I, Husmann M
Division of Angiology and Vascular Surgery, Cardiovascular Department, Inselspital Bern, University Hospital and University of Bern, Switzerland.
Vasa. 2008 Aug;37(3):281-4. doi: 10.1024/0301-1526.37.3.281.
Trousseau Syndrome is a paraneoplastic procoagulant phenomenon. Heparin-induced thrombocytopenia (HIT) is a rare complication of anticoagulation with heparin. To our knowledge, the coincidence of the two has not been reported so far. We report a case of an acute thrombosis of the left femoral artery and distal leg arteries in a patient with an otherwise normal cardiovascular status. Endovascular revascularization attempts using mechanical rotational thrombectomy catheter, aspiration and local thrombolysis were unsuccessful. Progressive coagulation along the intra-arterial catheter was seen. Surgical thrombectomy of the femoral-pedal axis was successful, but the patient developed an immune-mediated HIT postoperatively. An adenocarcinoma of the colon was the likely cause for the initial arterial thrombosis, and probably adversely affected endovascular revascularization attempts. Subsequent HIT with microvascular thrombosis worsened ischemic damage leading to a below knee-amputation, despite patent large vessels. Compared to venous thrombosis, arterial thrombosis is a rare manifestation of Trousseau syndrome. The coincidence of it with HIT is even rarer. There may be a causal relationship between the two.
特鲁索综合征是一种副肿瘤性促凝现象。肝素诱导的血小板减少症（HIT）是肝素抗凝治疗的一种罕见并发症。据我们所知，两者同时出现的情况迄今为止尚未见报道。我们报告一例心血管状况正常的患者发生左股动脉及小腿远端动脉急性血栓形成的病例。使用机械旋转血栓切除术导管、抽吸及局部溶栓进行血管内血运重建的尝试均未成功。可见沿动脉内导管出现进行性凝血。股-足轴的外科血栓切除术成功，但患者术后发生了免疫介导的HIT。结肠腺癌可能是最初动脉血栓形成的原因，且可能对血管内血运重建的尝试产生了不利影响。尽管大血管通畅，但随后发生的HIT伴微血管血栓形成使缺血性损伤恶化，导致患者行膝下截肢。与静脉血栓形成相比，动脉血栓形成是特鲁索综合征的罕见表现。其与HIT同时出现的情况更为罕见。两者之间可能存在因果关系。
