title: Recurrent acute lower-limb ischemia with multiple organ infarctions secondary to acute myeloid leukaemia M1.
abstract: BACKGROUND
  Acute myeloid leukemia (AML) is usually associated with coagulopathy and disorders of hemostasis, but cases of ischemic events have been reported. We present a case of AML with recurrent acute limb ischemia and multiple organ infarctions.
  
  
  RESULTS
  A 57-year-old woman diagnosed with AML subtype M1 developed recurrent bilateral acute lower-limb ischemia refractory to multiple thromboembolectomies and bypass grafting. Histopathology revealed that thrombi were composed of leukemic blasts, and computed tomography angiogram incidentally revealed multiple infarctions. She demonstrated a response to chemotherapy, but died of an overwhelming sepsis 22 days after her acute admission.
  
  
  CONCLUSIONS
  AML subtype M1 with acute lower-limb ischemia and multiple organ infarctions is associated with a poor prognosis. The role of emergency chemotherapy in reducing the tumour burden and possibly improving the results of vascular interventions needs to be defined. Limb-salvaging surgery should not be delayed but be administered immediately according to the degree of ischemia.
authors.affiliation: Department of Vascular Surgery, Barts and the London NHS Trust, London, UK. overtonjohn@hotmail.com
authors.forename: John
authors.initials: J
authors.lastname: Overton
authors.forename: Angela
authors.initials: A
authors.lastname: Nicklin
authors.forename: Perla
authors.initials: P
authors.lastname: Eleftheriou
authors.forename: Daniel
authors.initials: D
authors.lastname: Frith
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Gravante
authors.forename: Wayne
authors.initials: W
authors.lastname: Sapsford
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017128:Embolectomy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007238:Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007668:Kidney / Q000098:blood supply*; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D035002:Lower Extremity / Q000098:blood supply*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D012008:Recurrence; D018805:Sepsis / Q000209:etiology; D013159:Splenic Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed; D058017:Vascular Grafting