Acute Critical Leg Ischemia: An Uncommon Initial Manifestation of Esophageal Adenocarcinoma

Abstract

This report describes a patient who presented with acute critical right leg ischemia leading to the diagnosis of esophageal adenocarcinoma with widespread metastases. His limb was salvaged with urgent thromboembolectomy. However, he died 3 weeks after presentation due to progressive cancer. Pathogenesis of arterial thromboembolism in the setting of malignancy remains uncertain but multiple factors probably contribute to this phenomenon. Management is challenging and conservative approach is generally advocated especially when the prognosis related to the malignancy is poor. When arterial thromboembolism develops in patients with malignancy, the prognosis is usually very poor. Therefore, acute arterial thromboembolism has been suggested as an agonal event. Where possible in such setting, revascularisation can be attempted to provide pain relief and improve quality of life but major vascular reconstructive surgery is not recommended in most cases.