title: Acute limb ischemia in cancer patients: should we surgically intervene?
abstract: BACKGROUND
  Cancer patients have an increased risk of venous thromboembolic events. Certain chemotherapeutic agents have also been associated with the development of thrombosis. Reported cases of acute arterial ischemic episodes in cancer patients are rare.
  
  
  METHODS
  Patients who underwent surgery for acute limb ischemia associated with malignancy in a university teaching hospital over a 10-year period were identified. Patient demographics, cancer type, chemotherapy use, site of thromboembolism, treatment and outcome were recorded.
  
  
  RESULTS
  Four hundred nineteen patients underwent surgical intervention for acute arterial ischemia, 16 of these patients (3.8%) had associated cancer. Commonest cancer sites were the urogenital tract (n = 5) and the lungs (n = 5). Eight patients (50%) had been recently diagnosed with cancer, and four (25%) of these cancers were incidental findings after presentation with acute limb ischemia. Four patients (25%) developed acute ischemia during chemotherapy. The superficial femoral artery was the most frequent site of occlusion (50%), followed by the brachial (18%) and popliteal (12%) arteries. All patients underwent thromboembolectomy, but two (12%) patients subsequently required a bypass procedure. Six patients (37%) had limb loss, and in-patient mortality was 12%. Histology revealed that all occlusions were due to thromboembolism, with no tumor cells identified. At follow-up, 44% of patients were found to be alive after 1 year.
  
  
  CONCLUSIONS
  Cancer and chemotherapy can predispose patients to acute arterial ischemia. Unlike other reports that view this finding as a preterminal event most appropriately treated by palliative measures, in this series, early diagnosis and surgical intervention enabled limb salvage and patient survival.
authors.affiliation: Department of Vascular Surgery, Royal College of Surgeons Ireland, Beaumont Hospital, Dublin, Ireland. julianst@yahoo.com
authors.forename: Julian S
authors.initials: JS
authors.lastname: Tsang
authors.forename: Peter A
authors.initials: PA
authors.lastname: Naughton
authors.forename: Jill
authors.initials: J
authors.lastname: O'Donnell
authors.forename: Tim T
authors.initials: TT
authors.lastname: Wang
authors.forename: Daragh S
authors.initials: DS
authors.lastname: Moneley
authors.forename: Cathal J
authors.initials: CJ
authors.lastname: Kelly
authors.forename: Austin L
authors.initials: AL
authors.lastname: Leahy
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005121:Extremities / Q000098:blood supply*; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007494:Ireland; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D054556:Venous Thromboembolism / Q000209:etiology / Q000401:mortality / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents