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Recurrent acute lower-limb ischemia with multiple organ infarctions secondary to acute myeloid leukaemia M1
John Overton1, Angela Nicklin, Perla Eleftheriou
1Department of Vascular Surgery, Barts and the London NHS Trust, London, UK. overtonjohn@hotmail.com
Background:
Acute myeloid leukemia (AML) is usually associated with coagulopathy and disorders of hemostasis, but cases of ischemic events have been reported. We present a case of AML with recurrent acute limb ischemia and multiple organ infarctions.
Methods And Results:
A 57-year-old woman diagnosed with AML subtype M1 developed recurrent bilateral acute lower-limb ischemia refractory to multiple thromboembolectomies and bypass grafting. Histopathology revealed that thrombi were composed of leukemic blasts, and computed tomography angiogram incidentally revealed multiple infarctions. She demonstrated a response to chemotherapy, but died of an overwhelming sepsis 22 days after her acute admission.
Conclusions:
AML subtype M1 with acute lower-limb ischemia and multiple organ infarctions is associated with a poor prognosis. The role of emergency chemotherapy in reducing the tumour burden and possibly improving the results of vascular interventions needs to be defined. Limb-salvaging surgery should not be delayed but be administered immediately according to the degree of ischemia.
