Tsang Julian S, Naughton Peter A, O'Donnell Jill, Wang Tim T, Moneley Daragh S, Kelly Cathal J, Leahy Austin L
Department of Vascular Surgery, Royal College of Surgeons Ireland, Beaumont Hospital, Dublin, Ireland.
Ann Vasc Surg. 2011 Oct;25(7):954-60. doi: 10.1016/j.avsg.2011.06.002. Epub 2011 Aug 6.
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.
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.
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.
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.
癌症患者发生静脉血栓栓塞事件的风险增加。某些化疗药物也与血栓形成有关。癌症患者急性动脉缺血发作的报道病例很少。
确定在一所大学教学医院10年间因与恶性肿瘤相关的急性肢体缺血而接受手术的患者。记录患者的人口统计学资料、癌症类型、化疗使用情况、血栓栓塞部位、治疗方法及结果。
419例患者因急性动脉缺血接受了手术干预，其中16例患者（3.8%）患有相关癌症。最常见的癌症部位是泌尿生殖道（5例）和肺部（5例）。8例患者（50%）最近被诊断患有癌症，其中4例（25%）的癌症是在出现急性肢体缺血后偶然发现的。4例患者（25%）在化疗期间发生急性缺血。股浅动脉是最常见的闭塞部位（50%），其次是肱动脉（18%）和腘动脉（12%）。所有患者均接受了血栓切除术，但有2例患者（12%）随后需要进行搭桥手术。6例患者（37%）肢体丧失，住院死亡率为12%。组织学检查显示所有闭塞均由血栓栓塞引起，未发现肿瘤细胞。随访时发现，44%的患者在1年后仍存活。
癌症和化疗可使患者易患急性动脉缺血。与其他将这一发现视为终末期事件且最适合采用姑息措施治疗的报道不同，在本系列研究中，早期诊断和手术干预使肢体得以挽救，患者得以存活。
