Boussi Leora, Safaya Aditya, Goyal Arun, Mateo Romeo, Laskowski Igor, Babu Sateesh
Department of Vascular Surgery, 497001Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Vasc Endovascular Surg. 2020 Oct;54(7):646-649. doi: 10.1177/1538574420939360. Epub 2020 Jul 8.
Inflammatory bowel disease (IBD) is a chronic multisystem inflammatory condition with associated endothelial dysfunction and dysregulated coagulation. Although deep venous thrombosis (DVT) in IBD has been well described, arterial thrombosis and thromboembolism are less commonly appreciated.
A 63-year-old male with a known history of Crohn disease presented with acute-onset right arm pain. His past vascular history was significant for left lower extremity DVT with an existing inferior vena cava filter and acute ischemia of the right lower extremity requiring a below-knee amputation a year ago. Imaging revealed acute brachial, ulnar, and radial artery thrombosis.
Patient underwent an open right brachial, radial, and ulnar thrombectomy to restore vascular flow. He required multiple exploration and thrombectomy for reocclusion of the vessels in the early postoperative period. He later developed a rapidly deteriorating clinical status, flank ecchymosis and swelling concerning for soft tissue ischemia, and compartment syndrome heralding an eventual hemodynamic collapse. On exploration, he was found to have chronic fibrosis of his left femoral vein and femoral artery occlusion. Clinically, the patient deteriorated rapidly, which resulted in his demise.
The inflammatory reaction in IBD leads to arterial stiffening and hypercoagulability, which should theoretically increase the risk for vascular disease. Although the link between IBD and DVT is well established, arterial thrombosis and thromboembolism remain widely debated, with some implications for therapeutic intervention. The link between vascular thrombosis and IBD must be examined further, as the treatment and prevention of vascular complications in IBD depends on our understanding of this relationship.
炎症性肠病（IBD）是一种慢性多系统炎症性疾病，伴有内皮功能障碍和凝血失调。虽然IBD中的深静脉血栓形成（DVT）已得到充分描述，但动脉血栓形成和血栓栓塞较少受到关注。
一名63岁有克罗恩病病史的男性出现急性右臂疼痛。他过去的血管病史包括左下肢DVT，植入了下腔静脉滤器，以及一年前右下肢急性缺血，需要进行膝下截肢。影像学检查显示肱动脉、尺动脉和桡动脉急性血栓形成。
患者接受了开放性右肱动脉、桡动脉和尺动脉血栓切除术以恢复血管血流。术后早期他因血管再次闭塞需要多次探查和血栓切除术。他后来临床状况迅速恶化，出现侧腹瘀斑和肿胀，提示软组织缺血，以及骨筋膜室综合征，最终导致血流动力学崩溃。探查发现他左股静脉慢性纤维化和股动脉闭塞。临床上，患者迅速恶化，最终死亡。
IBD中的炎症反应导致动脉僵硬和高凝状态，理论上这会增加血管疾病的风险。虽然IBD与DVT之间的联系已得到充分证实，但动脉血栓形成和血栓栓塞仍存在广泛争议，对治疗干预有一定影响。IBD与血管血栓形成之间的联系必须进一步研究，因为IBD中血管并发症的治疗和预防取决于我们对这种关系的理解。
