Key result
Urgent thromboembolectomy salvaged the ischemic limb of a patient with metastatic esophageal adenocarcinoma, though the patient died 3 weeks later from progressive cancer.
Case Report (n=1)
Acute arterial thromboembolism can be an agonal event in patients with malignancy, where revascularization may provide palliation but overall prognosis remains poor.
Should not change practice in advanced cancer; hypothesis-generating for limb salvage in select patients with acute ischemia.
This report describes a patient who presented with acute critical right leg ischemia leading to the diagnosis of esophageal adenocarcinoma with widespread metastases. His limb was salvaged with urgent thromboembolectomy. However, he died 3 weeks after presentation due to progressive cancer. Pathogenesis of arterial thromboembolism in the setting of malignancy remains uncertain but multiple factors probably contribute to this phenomenon. Management is challenging and conservative approach is generally advocated especially when the prognosis related to the malignancy is poor. When arterial thromboembolism develops in patients with malignancy, the prognosis is usually very poor. Therefore, acute arterial thromboembolism has been suggested as an agonal event. Where possible in such setting, revascularisation can be attempted to provide pain relief and improve quality of life but major vascular reconstructive surgery is not recommended in most cases.
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Yong et al. (2009) conducted a case report in Acute critical leg ischemia and esophageal adenocarcinoma (n=1). Urgent thromboembolectomy was evaluated on Limb salvage and survival. Urgent thromboembolectomy salvaged the ischemic limb of a patient with metastatic esophageal adenocarcinoma, though the patient died 3 weeks later from progressive cancer.
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