Key result
Endovascular revascularization with overnight tissue plasminogen activator infusion successfully restored arterial flow and resolved acute limb ischemia symptoms in a patient with repaired Tetralogy of Fallot and concurrent pulmonary embolism.
Why the study?
Simultaneous acute limb ischemia and pulmonary embolism are extremely rare, with the current literature providing a limited understanding of shared mechanisms.
Case Report (n=1)
Adults with repaired tetralogy of Fallot may be at risk for rare, concurrent thromboembolic events like acute limb ischemia and pulmonary embolism, requiring multidisciplinary management.
Suggests endovascular thrombolysis feasibility in repaired tetralogy of Fallot with concurrent embolism; hypothesis-generating for rare thromboembolic management.
Simultaneous acute limb ischemia (ALI) and pulmonary embolism (PE) are extremely rare, with the current literature providing a limited understanding of shared mechanisms. We report a rare case of concurrent ALI and PE presentation in a patient with a history of repaired tetralogy of Fallot (TOF), emphasizing the possible association between congenital heart disease and thromboembolic risk, potentially through residual hemodynamic abnormalities or arrhythmias. The case involves a 48-year-old male with a history of TOF repair in childhood who developed simultaneous ALI and PE approximately 48 years after the surgical repair. The patient presented with sudden right lower extremity pain and swelling; was classified as Rutherford IIa ALI; and underwent urgent endovascular revascularization that included an overnight tissue plasminogen activator infusion and a relook angiogram the next day. During admission, the common embolic etiologies of his presentation were excluded by multiple investigations, including transthoracic echocardiography, thrombophilia panel, and occult malignancy screens. Although the patient had multiple cardiovascular risk factors, including obesity, smoking, and hypertension, it is most likely the history of TOF repair that contributed the most to the concurrent thromboembolic presentation, especially given that TOF repair has been reported to be associated with chronic complications in adult patients, such as persistent right ventricular dysfunction and arrhythmias. A multidisciplinary team of interventional cardiologists, pulmonologists, and hematologists managed the case, reflecting the difficulty of managing concomitant thromboembolic events and monitoring and evaluating thromboembolic risk factors for treated congenital heart disease, most specifically TOF, in adult patients.
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Abu-Wardeh et al. (2025) conducted a case report in Concurrent Acute Limb Ischemia and Pulmonary Embolism (n=1). Endovascular revascularization and catheter-directed thrombolysis was evaluated on Restoration of arterial flow and resolution of acute limb ischemia symptoms. Endovascular revascularization with overnight tissue plasminogen activator infusion successfully restored arterial flow and resolved acute limb ischemia symptoms in a patient with repaired Tetralogy of Fallot and concurrent pulmonary embolism.
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