title: Vascular limb occlusion in twin-twin transfusion syndrome (TTTS): case series and literature review.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the phenomenon of vascular ischemic limb necrosis in twin-twin transfusion syndrome (TTTS).
  
  
  METHODS
  This was a multicenter retrospective review of ischemic limb necrosis in patients with TTTS.
  
  
  RESULTS
  Twenty cases of fetal ischemic limb necrosis in association with TTTS were identified from 10 fetal medicine centers. The recipient was affected in 19 cases, and the lower limb was affected in 17 cases. The extent of the damage correlated with TTTS severity. Eighty percent of limb defects (16/20) clearly were unrelated to laser treatment (3 cases untreated, 7 cases after amnioreduction, 6 cases present at time of laser). The recipient was relatively polycythemic in 5 of 7 cases in which neonatal or fetal hemoglobin/hematocrit levels were available.
  
  
  CONCLUSIONS
  Ischemic limb necrosis is a rare complication of TTTS. The lesion is unrelated to therapy and may be the result of polycythemia, hypertension, and vasoconstriction.
authors: Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
authors: Susanne
authors: S
authors: Schrey
authors: Agnes
authors: A
authors: Huber
authors: Kurt
authors: K
authors: Hecher
authors: Rubén
authors: R
authors: Quintero
authors: Fawaz
authors: F
authors: Alkazaleh
authors: Kenneth J
authors: KJ
authors: Moise
authors: John R
authors: JR
authors: Allbert
authors: Carol
authors: C
authors: Schneider
authors: Mario
authors: M
authors: Palermo
authors: Yoav
authors: Y
authors: Yinon
authors: Ramen H
authors: RH
authors: Chmait
authors: Rory
authors: R
authors: Windrim
authors: Greg
authors: G
authors: Ryan
mesh_terms: D000671:Amputation, Surgical; D005260:Female; D005313:Fetal Death; D005330:Fetofetal Transfusion / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D007511:Ischemia / Q000209:etiology*; D017075:Laser Coagulation; D035002:Lower Extremity / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D009336:Necrosis; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal; D012189:Retrospective Studies; D012720:Severity of Illness Index; D034941:Upper Extremity / Q000098:blood supply* / Q000473:pathology / Q000601:surgery