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International Angiology 2020 Nov 03

DOI: 10.23736/S0392-9590.20.04505-8


language: English

Characteristics and clinical indicators of concomitant venous thromboembolism in acute limb ischemia

Ruihao LI 1, Siying LING 1, Bo XU 2, Wei WEI 1, Shixiong YU 1, Wu YU 1, Yikuan CHEN 1

1 Department of Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China; 2 Department of Cardiothoracic Surgery, Second Affiliated Hospital, Army Medical University, Chongqing, China

BACKGROUND: Venous thromboembolism (VTE) concomitant to acute limb ischemia (ALI) is rarely reported. The purposes of the study were to investigate characteristics and identify clinical indicators of VTE in patients with ALI.
METHODS: Electronic medical record was used to identify patients diagnosed with ALI from January 2013 to June 2019. Eligible patients were categorized as VTE or non-VTE based on the presence or absence of concomitant VTE. Univariate analysis and multivariate analysis for indicators of VTE were performed.
RESULTS: A total of 153 patients with 161 ischemic limbs were enrolled. Venous duplex ultrasound (DUS) for 149 patients (157 ischemic limbs) revealed deep vein thrombosis (DVT) in 38 (24.2%) ischemic limbs of 37 (24.8%) patients. Five femoral DVTs were found intraoperatively. Six patients had pulmonary embolism (PE) and three of them died. In all, 43 (28.1%) ALI patients were diagnosed with VTE. They were treated with trans-arterial catheter-directed thrombolysis (n=22), embolectomy (n=9), primary amputation (n=4) and anticoagulation alone (n=8). The univariate analysis indicated that symptoms ≥ 2 days [odds ratio (OR): 3.42, 95%CI:1.54-7.62], Rutherford classification Ⅱb-Ⅲ (OR: 9.17, 95%CI: 2.10-40.12), leg swelling (OR: 4.44, 95%CI: 2.07-9.53), neutrophil ratio ≥ 0.80 (OR: 3.92, 95%CI: 1.72-8.93) and positive D-dimer (OR: 8.44, 95%CI: 3.65-19.53) were indicators of VTE concomitant to ALI. In the multivariate analysis, leg swelling and positive D-dimer appeared to be independent indicators.
CONCLUSIONS: VTE commonly occurs to ALI. Venous DUS for DVT screening should be considered for ALI patients who present one or more of these indicators.

KEY WORDS: Acute limb ischemia; Deep vein thrombosis; Pulmonary embolism; Venous thromboembolism

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