Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
City University of NY (CUNY) School of Medicine, 160 Convent Avenue, Convent Ave, New York, NY, 10031, USA.
BMC Cancer. 2021 Aug 13;21(1):916. doi: 10.1186/s12885-021-08659-x.
Acute Limb Ischemia (ALI) carries a high morbidity and mortality rate that is compounded in the cancer patient. Though it is a relatively uncommon event, it is of extremely high adverse impact and carries poor awareness among clinicians.
Retrospective review of electronic medical records was performed of cancer patients presenting with acute limb ischemia (ALI) to the tertiary cancer center's urgent care center or as inpatient between January 1, 2014 and January 1, 2020.
Out of the 29 cancer patients with ALI, 12 (41%) died within 3 month and 9 (31%) patients died within 1 months of ALI diagnosis. 65% had long term adverse outcome after ALI - 31% with death in 1 month, 2 (7%) with an amputation, 5 (17%) with lifestyle-limiting claudication, and 3 (10%) with subsequent wound ulceration or gangrene. Patients not eligible for standard of care (12 patients, 41%) (RR 2.33 95% CI [1.27-4.27], p < 0.01) and heparin administration ≥6 h from presentation (19 patients, 65%) (RR 2.81 [1.07-7.38], p = 0.04) were at increased risk of adverse outcome. Atypical/confounded presentation of ALI (13 patients, 45%) (RR 1.84 95% CI [1.03-3.29], p = 0.04), pulse exam not documented (12 patients, 41.4%) (RR 1.95 [95% CI [1.14-3.32], p = 0.01), and patients with services other than a vascular specialist initially consulted (8 patients, 27.6%) (RR 1.91 95% CI [1.27-2.87], p < 0.01) were significant risk factors for heparin administered ≥6 h from presentation.
ALI is devastating in cancer patients, with a high number presenting with atypical/confounded signs and symptoms which delays treatment. Heparin administered ≥6 h from presentation is associated with adverse outcome.
急性肢体缺血（ALI）具有较高的发病率和死亡率，在癌症患者中更为严重。尽管它是一种相对罕见的事件，但对临床医生来说，其影响极为严重，且认知度较低。
对 2014 年 1 月 1 日至 2020 年 1 月 1 日期间，三级癌症中心急救中心或住院部就诊的癌症合并急性肢体缺血（ALI）患者的电子病历进行回顾性分析。
29 例 ALI 癌症患者中，12 例（41%）在 3 个月内死亡，9 例（31%）在 ALI 诊断后 1 个月内死亡。65%的患者在 ALI 后有长期不良预后，其中 31%在 1 个月内死亡，2 例（7%）截肢，5 例（17%）生活受限性跛行，3 例（10%）随后发生溃疡或坏疽。有 12 例（41%）患者不符合标准治疗（RR 2.33，95%CI[1.27-4.27]，p<0.01）和肝素治疗开始后≥6 h（19 例，65%）（RR 2.81[1.07-7.38]，p=0.04）的患者发生不良预后的风险增加。ALI 表现不典型/复杂（13 例，45%）（RR 1.84，95%CI[1.03-3.29]，p=0.04）、未记录脉搏检查（12 例，41.4%）（RR 1.95[95%CI [1.14-3.32]，p=0.01）以及最初咨询的不是血管专科医生（8 例，27.6%）（RR 1.91，95%CI[1.27-2.87]，p<0.01）的患者是肝素治疗开始后≥6 h 的显著危险因素。
ALI 在癌症患者中是毁灭性的，有相当多的患者表现出不典型/复杂的症状和体征，这会延迟治疗。肝素治疗开始后≥6 h 与不良预后相关。
