Abu-Wardeh Anas A, Anabtawi Abdel G
Cardiology, Jordan University of Science and Technology, Irbid, JOR.
Interventional Cardiology, First Coast Cardiovascular Institute, Jacksonville, USA.
Cureus. 2025 Apr 3;17(4):e81665. doi: 10.7759/cureus.81665. eCollection 2025 Apr.
Simultaneous acute limb ischemia (ALI) and pulmonary embolism (PE) are extremely rare, with the current literature providing a limited understanding of shared mechanisms. We report a rare case of concurrent ALI and PE presentation in a patient with a history of repaired tetralogy of Fallot (TOF), emphasizing the possible association between congenital heart disease and thromboembolic risk, potentially through residual hemodynamic abnormalities or arrhythmias. The case involves a 48-year-old male with a history of TOF repair in childhood who developed simultaneous ALI and PE approximately 48 years after the surgical repair. The patient presented with sudden right lower extremity pain and swelling; was classified as Rutherford IIa ALI; and underwent urgent endovascular revascularization that included an overnight tissue plasminogen activator infusion and a relook angiogram the next day. During admission, the common embolic etiologies of his presentation were excluded by multiple investigations, including transthoracic echocardiography, thrombophilia panel, and occult malignancy screens. Although the patient had multiple cardiovascular risk factors, including obesity, smoking, and hypertension, it is most likely the history of TOF repair that contributed the most to the concurrent thromboembolic presentation, especially given that TOF repair has been reported to be associated with chronic complications in adult patients, such as persistent right ventricular dysfunction and arrhythmias. A multidisciplinary team of interventional cardiologists, pulmonologists, and hematologists managed the case, reflecting the difficulty of managing concomitant thromboembolic events and monitoring and evaluating thromboembolic risk factors for treated congenital heart disease, most specifically TOF, in adult patients.
急性肢体缺血（ALI）与肺栓塞（PE）同时发生极为罕见，目前的文献对其共同机制的了解有限。我们报告了一例罕见的病例，一名法洛四联症（TOF）修复术后的患者同时出现ALI和PE，强调了先天性心脏病与血栓栓塞风险之间可能存在的关联，这可能是通过残余血流动力学异常或心律失常导致的。该病例为一名48岁男性，儿童时期有TOF修复病史，在手术修复约48年后同时发生ALI和PE。患者出现右下肢突然疼痛和肿胀；被分类为卢瑟福IIa级ALI；并接受了紧急血管内血运重建，包括夜间组织纤溶酶原激活剂输注及次日复查血管造影。入院期间，通过多项检查排除了其症状常见的栓塞病因，包括经胸超声心动图、血栓形成倾向检查及隐匿性恶性肿瘤筛查。尽管患者有多种心血管危险因素，包括肥胖、吸烟和高血压，但最有可能是TOF修复病史对同时发生的血栓栓塞表现起了最大作用，特别是考虑到据报道TOF修复与成年患者的慢性并发症相关，如持续性右心室功能障碍和心律失常。一个由介入心脏病学家、肺科医生和血液科医生组成的多学科团队对该病例进行了管理，这反映了在成年患者中管理合并血栓栓塞事件以及监测和评估已治疗先天性心脏病（最特别是TOF）的血栓栓塞危险因素的困难。
