Arterial embolism to the upper extremity in a patient with factor V Leiden mutation (APC resistance)--a case report and review of the literature.
Factor V Leiden mutation has emerged as one of the leading abnormalities in inherited blood coagulation disorders, resulting in a markedly increased risk for deep leg vein thrombosis. A 24-year-old woman presented with acute onset of critical ischemia of her left thumb and index finger. Intraarterial angiography revealed an embolus in the distal radial artery and a thrombotic occlusion of the digital artery of the thumb and index finger. Immediate therapy encompassed a selective surgical embolectomy of the distal radial artery followed by a local intraarterial lysis that was continued for 3 days. Additionally, therapeutic anticoagulation and vasodilating drugs (prostaglandin E) were administered. Within 2 days, capillary refill reappeared and the initial loss of sensory function at the tip of the thumb and index finger diminished. A screening test for thrombophilic disorders led to the diagnosis of a heterozygous mutation of factor V (Leiden mutation). Arterial thromboembolic events of factor V Leiden mutation are rare and have to date been described only in the supraaortic and coronary circulation. Therefore, the arterial embolism to the left hand presented in this report constitutes a rarity that could be successfully salvaged by the combined use of a vascular surgical procedure and intensified medical management.
Dorweiler
B
B
Department of Cardiothoracic and Vascular Surgery, University Hospital, Johannes-Gutenberg University, Langenbeckstrasse 1, 55101 Mainz, Germany. dorweiler@htg.klinik.uni-mainz.de
Neufang
A
A
Kasper-Koenig
W
W
Schinzel
H
H
Schmiedt
W
W
Oelert
H
H
D020016:Activated Protein C Resistance / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D000328:Adult; D005260:Female; D005385:Fingers / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013933:Thumb / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery