Infrainguinal bypass surgery for chronic arterial occlusive disease associated with essential thrombocythemia: report

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Published on: April 21, 2023

Takaki Sugimoto1, Takashi Kitade, Takeshi Mimura

  • 1Department of Surgery, Hyogo Prefectural Awaji Hospital,Sumoto, Hyogo 656-0013, Japan.

Surgery Today
|June 29, 2004
PubMed

Insights

This case study highlights managing peripheral artery disease in essential thrombocythemia. Strict medication adherence is crucial for maintaining infrainguinal bypass graft patency and patient mobility.

Area of Science:

  • Vascular Surgery
  • Hematology
  • Thrombotic Disorders

Background:

  • Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by elevated platelet counts, increasing the risk of thrombotic events.
  • Bilateral infrainguinal artery occlusion presents a significant challenge for peripheral artery disease (PAD) management, often requiring complex revascularization strategies.

Observation:

  • A 63-year-old male patient with a 3-year history of intermittent claudication presented with total occlusion of bilateral infrainguinal arteries.
  • The patient was diagnosed with essential thrombocythemia based on elevated platelet count (172 x 10^4/mm^3) and bone marrow findings.
  • Infrainguinal bypass surgery using saphenous vein and prosthetic grafts was performed after medical management improved platelet aggregation.

Findings:

  • Bilateral grafts remained patent for 10 months postoperatively.
  • Discontinuation of medication led to acute prosthetic graft occlusion.
  • Prompt thrombectomy successfully salvaged the occluded graft.

Implications:

  • This case underscores the critical importance of strict medication adherence in patients with ET undergoing infrainguinal bypass surgery.
  • Effective management of ET and PAD can restore mobility and improve quality of life.
  • Multidisciplinary management involving hematology and vascular surgery is essential for optimizing outcomes in complex cases.

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