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Paradoxical embolus: an unusual indication for upper limb amputation.
S K Patel1, M Tomlinson, A Anjum
1Department of Vascular Surgery, St George's Hospital, London, UK.
Annals of the Royal College of Surgeons of England
|January 5, 2002
Summary
Paradoxical emboli, where clots travel from veins to arteries via a heart defect, can cause limb-threatening ischemia. This case details a rare emergency arm amputation due to double paradoxical emboli after long travel.
Area of Science:
- Cardiology
- Vascular Surgery
- Embolism Research
Background:
- Paradoxical emboli involve venous thromboembolism shunting to arterial circulation, typically via a right-to-left cardiac shunt.
- Arterial ischemia, particularly cerebral infarcts, is a known complication of paradoxical emboli.
- The occurrence of paradoxical emboli is often associated with underlying cardiac or pulmonary conditions facilitating shunting.
Observation:
- A case of double paradoxical emboli occurred in a patient following a long-haul flight.
- The emboli led to severe arterial ischemia in an upper limb.
- This resulted in the necessity for emergency amputation of the affected limb.
Findings:
- This report describes the first known case of emergency limb amputation secondary to paradoxical emboli.
- The patient experienced bilateral upper limb emboli, necessitating surgical intervention.
- The etiology was linked to prolonged immobility during air travel, predisposing to venous thromboembolism.
Implications:
- Highlights the potential for severe arterial complications from paradoxical emboli beyond cerebral events.
- Underscores the risk of venous thromboembolism and paradoxical embolization in individuals undergoing long-duration travel.
- Suggests the need for increased vigilance and potential prophylactic measures in at-risk populations.