Acute limb ischemia in a cancer patient has high morbidity, high mortality, and atypical presentation: a tertiary cancer center’s retrospective study

BMC Cancer

Amoateng Emmanuel¹  Etay Ziv²  Ernesto Santos Martin²  Yolanda Bryce²  Christopher Harnain³  Samantha Huq³  Christopher Agrusa³ 

[1] City University of NY (CUNY) School of Medicine, 160 Convent Avenue, Convent Ave, 10031, New York, NY, USA;Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 10065, New York, NY, USA;New York Presbyterian Hospital Weill Cornell Medical Center, 525 East 68th Street Starr 8, 10065, New York, NY, USA;

关键词: Acute limb ischemia;    cancer patient;    Atypical presentation;    Peripheral arterial disease;    embolus;   

DOI  :  10.1186/s12885-021-08659-x

来源: Springer

【 摘 要 】

BackgroundAcute 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.MethodsRetrospective 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.ResultsOut 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.ConclusionsALI 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.

【 授权许可】

CC BY