A Case of Repeated Acute Limb Ischemia with Malignant Tumor / 日本心臓血管外科学会雑誌

ABSTRACT

A 72-year-old man had undergone aorto-bifemoral bypass for Leriche syndrome at age 67, but acute limb ischemia developed three times after the first operation, in January 2008, April 2008, and April 2009. There were no abnormal heart rhythms or thrombotic factors, and he had received anticoagulant therapy with warfarin (target prothrombin time-international normalized ratio 1.7 to 3.0) since January 2008. Nevertheless, he came to our hospital because of sudden onset of severe pain in the right lower limb in April 2010. Since CT showed occlusions in the right leg involving the aortobifemoral bypass and femoropopliteal bypass graft, emergency thrombectomy and femoropopliteal bypass (below knee), was performed. CT on admission showed enlargement of lymph nodes around the stomach, and gastric cancer was diagnosed by esophagogastroduodenoscopy. Since we considered the hypercoagulability in this patient with cancer to have resulted in repeated acute arterial thrombosis, these episodes were broadly diagnosed as Trousseau's syndrome.