title: Critical Limb Ischemia Secondary to Antiphospholipid Syndrome in a Pediatric Patient: Case Report and Review.
abstract: BACKGROUND
  Antiphospholipid syndrome (APS) is a condition that manifests as venous or arterial thrombosis, as well as complications of pregnancy. APS affecting primarily the arteries is less common when compared to venous complications. We present a case of arterial occlusion resulting in critical limb ischemia (CLI) in a pediatric patient.
  
  
  METHODS
  A 14-year old boy presented with worsening right lower extremity pain and ulcerative lesions of his foot. Laboratory analysis revealed a diagnosis of APS. This case report and review of the literature expands our understanding of arterial manifestations of APS in the pediatric patient.
  
  
  RESULTS
  The patient was discovered to have proximal occlusion of the superficial femoral artery (SFA), the distal popliteal artery, the anterior tibial artery at the mid-calf, and the posterior tibial artery at the ankle. He underwent a common femoral artery to above-knee-popliteal artery bypass with reversed greater saphenous graft. Follow up after over one-year demonstrated an ABI of 1.0 and no evidence of stenosis in the bypass graft on duplex ultrasound (DUS).
  
  
  CONCLUSIONS
  APS is a complex syndrome with a variety of clinical presentations. This case highlights arterial manifestations of APS and reviews the expanding literature to guide improved patient outcomes.
authors.affiliation: Division of Vascular Surgery, The Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD. Electronic address: andrew.j.soohoo@gmail.com.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Soo Hoo
authors.affiliation: Division of Vascular Surgery, The Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: White
authors.affiliation: Division of Vascular Surgery, The Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Paul W
authors.initials: PW
authors.lastname: White
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000792:Angiography; D055109:Ankle Brachial Index; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D003097:Collateral Circulation; D016638:Critical Illness; D016523:Foot Ulcer / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D012039:Regional Blood Flow; D012307:Risk Factors; D012501:Saphenous Vein / Q000601:surgery; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D058017:Vascular Grafting / Q000379:methods; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants