PowerPoint Presentation
+IntroductionAcute limb ischemia (ALI) is a vascular
emergencyAssociated with significant morbidity and
mortalityEstablished the benefit of catheter-directed thrombolysis
and surgery in treating this conditionCatheter-directed
thrombolysis has been shown to improve limb salvage and to decrease
early mortality in selected patients.Urgent surgery is appropriate
if embolic etiology is suspected or if the limb is immediately
threatened, or when thrombolytic therapy is contraindicated. +Much
worse outcomes with certain comorbidities, including cancer.
Thrombolysis or Peripheral Arterial Surgery (TOPAS) trial, cancer
was present in 12% of patients with ALI (12% in the thrombolysis
arm, 11% in the surgical arm) Patients with cancer had a higher
rate of morbidity and mortalityOur objective was to describe and
evaluate the survival outcomes of cancer patients presenting with
and treated for ALI at our cancer center.+MethodsRetrospective
Cancer patients treated for ALI at The University of Texas MD
Anderson Cancer Center from 2001 to 2011. Patients were identified
: diagnostic codes, Criteria of concomitant malignancy and ALI
symptoms occurring within 15 days prior to admission. Excluded :
benign tumors or without active malignancy, iatrogenic limb
ischemia related to a tumor chemoembolization procedure. Age, sex,
type and stage of malignancy, type of chemotherapy, cardiovascular
risk factors and medications at the time of the ischemic event,
were extracted from the medical record and tabulated.The Rutherford
criteria classify the severity of limb ischemia based+Overall
survival (OS) : the time from the date of hospitalization with the
ischemic event to the date of death or last
follow-up.Amputation-free survival : the time from the date of
hospitalization for the ischemic event to the date of amputation or
death or last follow-up. The Kaplan-Meier method was used to
estimate overall survival outcomes.+ResultsJanuary 2001 and
December 2011 : 74 cancer patients with concomitant ALI that met
our inclusion criteria.
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+Pathology for 24 surgical patients : Thrombus-only 16 (67%),
Atherosclerosis with associated thrombus in 5 (20%) patients.
Direct tumor invasion of the arterial wall 2 (8%) cases. 1 patient
with leukemia had a pathologic specimen showing clot made of a
large aggregate of leukemic cells.+DiscussionThere is no invasive
approach for the management of ALI in cancer patients, including
surgical procedures, was associated with high mortality.ALI and
cancer patients are independently diverse and challenging. Thus,
patients suffering simultaneously from both conditions are
particularly difficult to manage. Multiple factors : symptoms at
presentation, severity of ischemia, cancer type, bleeding risks and
life expectancy management plan. The association between malignancy
and peripheral artery ischemic disease has long been recognized.
+1987 first patient with stable PAD got worsening of their
claudication symptoms when they developed cancer, followed by a
significant improvement when their malignancy responded to
therapy.TOPAS trial cancer (12% ) with ALI higher rate of morbidity
and mortality.Second most common cause of death in patients with
peripheral artery disease is malignancyThromboembolism a leading
cause of death in this population (9.2%)+Several mechanisms can
lead to arterial ischemic events in patients with cancer. Arterial
ischemia related to cardiovascular conditions, patients with an
underlying malignancy or a hematologic disorder have added risks
for in situ thrombosis related to acquired thrombophilia associated
with cancer and its therapy. Other potential mechanisms for
ischemia include tumor embolization, mechanical compression of
blood vessels by the neoplastic process, endothelial damage caused
by blood vessel catheterization, surgery, and chemotherapeutic
agents.+Limitations : no comparable controls. The retrospective
data collection also did not allow us to factor in other potential
benefits of invasive treatment for ALI, such as pain relief and
quality of life implications. Invasive approach for treatment of
ALI in cancer patients cannot be associated with high mortality
rate.Cancer patients with ALI should be managed in line with the
established standard of care for ALI in the regular
population+THANK YOU+
