Abstract
BackgroundAcute Limb Ischemia (ALI) carries a high morbidity and mortality rate that is compounded in the cancer patient. Though it is a relatively uncommon event, it is of extremely high adverse impact and carries poor awareness among clinicians.MethodsRetrospective review of electronic medical records was performed of cancer patients presenting with acute limb ischemia (ALI) to the tertiary cancer center’s urgent care center or as inpatient between January 1, 2014 and January 1, 2020.ResultsOut of the 29 cancer patients with ALI, 12 (41%) died within 3 month and 9 (31%) patients died within 1 months of ALI diagnosis. 65% had long term adverse outcome after ALI – 31% with death in 1 month, 2 (7%) with an amputation, 5 (17%) with lifestyle-limiting claudication, and 3 (10%) with subsequent wound ulceration or gangrene. Patients not eligible for standard of care (12 patients, 41%) (RR 2.33 95% CI [1.27–4.27], p < 0.01) and heparin administration ≥6 h from presentation (19 patients, 65%) (RR 2.81 [1.07–7.38], p = 0.04) were at increased risk of adverse outcome. Atypical/confounded presentation of ALI (13 patients, 45%) (RR 1.84 95% CI [1.03–3.29], p = 0.04), pulse exam not documented (12 patients, 41.4%) (RR 1.95 [95% CI [1.14–3.32], p = 0.01), and patients with services other than a vascular specialist initially consulted (8 patients, 27.6%) (RR 1.91 95% CI [1.27–2.87], p < 0.01) were significant risk factors for heparin administered ≥6 h from presentation.ConclusionsALI is devastating in cancer patients, with a high number presenting with atypical/confounded signs and symptoms which delays treatment. Heparin administered ≥6 h from presentation is associated with adverse outcome.
Highlights
Acute Limb Ischemia (ALI) carries a high morbidity and mortality rate that is compounded in the cancer patient
It is usually caused by peripheral arterial disease (PAD) with in situ thrombosis or embolus from a cardiac source due to arrythmias like atrial fibrillation [1, 2]
In the cancer patient, is a relatively uncommon event compared to the general population, but it is of extremely high adverse impact and carries poor awareness among clinicians, especially cancer specialists [3]
Summary
Acute Limb Ischemia (ALI) carries a high morbidity and mortality rate that is compounded in the cancer patient. Though it is a relatively uncommon event, it is of extremely high adverse impact and carries poor awareness among clinicians. Acute Limb Ischemia (ALI) is caused by sudden interruption of arterial blood flow to a limb (most often the lower extremity) threatening the viability of the limb, defined as acute (< 2 week), severe hypoperfusion of the limb characterized by pain, pallor, pulselessness, poikilothermia (cold), paresthesias, and paralysis [1]. The purpose of this study is to report a tertiary cancer center’s experience with ALI describing patient presentation, risk factors, and outcome associated with adverse outcome
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